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NPI Code Detail

MEDICARE: JESSICA HENDERSON

MEDICARE: JESSICA HENDERSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1326979634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA HENDERSON
Provider Business Mailing Address
First Line : 7033 E TUDOR RD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-1262
Country : US
Telephone Number : 907-729-8961
Fax Number : 907-729-5180
Provider Business Practice Location Address
First Line : 4441 DIPLOMACY DR
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-5910
Country : US
Telephone Number : 907-729-8880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ JESSICA HENDERSON ” Practice Location

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