Provider Demographics
NPI:1487873535
Name:BAUER, JODI LYNN (LPP,LBA, BCBA)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:BAUER
Suffix:
Gender:F
Credentials:LPP,LBA, BCBA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2325 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9411
Mailing Address - Country:US
Mailing Address - Phone:270-339-0127
Mailing Address - Fax:
Practice Address - Street 1:2325 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9411
Practice Address - Country:US
Practice Address - Phone:270-339-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0048103K00000X
KY0108103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist