Provider Demographics
NPI:1285143859
Name:ROTHMAN, JENNIFER DAWN (BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:ROTHMAN
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 1:5170 JUDGE LOGUE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352-8429
Mailing Address - Country:US
Mailing Address - Phone:254-349-7947
Mailing Address - Fax:254-227-5509
Practice Address - Street 1:212 W TROY ST STE B
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4455
Practice Address - Country:US
Practice Address - Phone:334-316-0442
Practice Address - Fax:254-227-5509
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-27835103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty