NPI 1104393123 · live from the CMS NPI Registry
Jessica Marie Childress
Behavior Analyst in North Pole, AK. National Provider Identifier 1104393123, active.
NPI record
| NPI | 1104393123 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 203 Santa Clause, North Pole, AK 99705 |
| Practice phone | 469-338-2901 |
| Enumerated | October 29, 2018 |
| Last updated | October 29, 2018 |
| Sole proprietor | No |
| Other names | Jessica Lail |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst primary | 103K00000X | RBT-18-69145 |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.