MEDICARE: JESSICA ROSE HERSHBERGER BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BA61520372	WA

General Provider Information

NPI Number	:	1225693120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ROSE HERSHBERGER BCBA, LBA

Provider Business Mailing Address
First Line	:	4600 25TH AVE NE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-0338
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 25TH AVE NE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-0338
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	05/21/2026

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