MEDICARE: JESSICA ACREE BCBA

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	6771	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-24-71635	OTHER		BACB

General Provider Information

NPI Number	:	1457060345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ACREE BCBA

Provider Business Mailing Address
First Line	:	1220 N ALMA DR STE 110
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-1198
Country	:	US
Telephone Number	:	469-730-0925
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 N ALMA DR STE 110
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-1198
Country	:	US
Telephone Number	:	214-432-3938
Fax Number	:

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

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	03/14/2024

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