Provider Demographics
NPI:1023348141
Name:RADIGAN, JENNIFER ANN (BS, BCABA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:RADIGAN
Suffix:
Gender:F
Credentials:BS, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N BELCHER RD
Mailing Address - Street 2:SUITE 249
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1339
Mailing Address - Country:US
Mailing Address - Phone:727-799-3330
Mailing Address - Fax:727-799-4632
Practice Address - Street 1:1501 N BELCHER RD
Practice Address - Street 2:SUITE 249
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1339
Practice Address - Country:US
Practice Address - Phone:727-799-3330
Practice Address - Fax:727-799-4632
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0093532103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst