Provider Demographics
NPI:1902155294
Name:FEHL, JENNIFER K (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:FEHL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WHITEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-5010
Mailing Address - Country:US
Mailing Address - Phone:609-351-5442
Mailing Address - Fax:609-265-2216
Practice Address - Street 1:25 WHITEHAVEN DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5010
Practice Address - Country:US
Practice Address - Phone:609-351-5442
Practice Address - Fax:609-265-2216
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-12-11587103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst