Provider Demographics
NPI:1003159245
Name:ENNS, JAMIE JEAN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:JEAN
Last Name:ENNS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:JEAN
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 N BRAND BLVD
Mailing Address - Street 2:1000
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1906
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:24303 WALNUT ST
Practice Address - Street 2:D
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2900
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:818-241-6853
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-23759103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst