Basic Information
| Provider Information | |||||||||
| NPI: | 1982225751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILVEIRA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MED, RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1321 MURFREESBORO PIKE STE 410 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372172626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153614000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 721 CHUCK GRAY CT | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423037308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707024641 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2020 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-20-114734 | IN | N | 193400000X SINGLE SPECIALTY GROUP | 103K00000X | KY | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.