Provider Demographics
NPI:1871146472
Name:GENTILE, JENNIFER LEE (BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:GENTILE
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 1:175 E COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-2101
Mailing Address - Country:US
Mailing Address - Phone:906-362-5536
Mailing Address - Fax:
Practice Address - Street 1:175 E COUNTY RD
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2101
Practice Address - Country:US
Practice Address - Phone:906-362-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty