Provider Demographics
NPI:1871359661
Name:COLLIER, JENNIFER LYNNE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WINGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:511 E IRVING AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1959
Mailing Address - Country:US
Mailing Address - Phone:248-607-2375
Mailing Address - Fax:
Practice Address - Street 1:30701 BARRINGTON ST STE 150
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5135
Practice Address - Country:US
Practice Address - Phone:248-965-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401002356103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst