Provider Demographics
NPI:1174381123
Name:HALL, JENNIFER HELEN (BCBA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:HELEN
Last Name:HALL
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 1:1950 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4614
Mailing Address - Country:US
Mailing Address - Phone:310-748-5879
Mailing Address - Fax:
Practice Address - Street 1:26944 ROLLING HILLS RD
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-4127
Practice Address - Country:US
Practice Address - Phone:310-541-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-20574103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst