MEDICARE: JESSICA RUTH SMITH

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

General Provider Information

NPI Number	:	1619860095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RUTH SMITH

Provider Business Mailing Address
First Line	:	660 STEPHENSON ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-4322
Country	:	US
Telephone Number	:	985-722-2860
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 STEPHENSON ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-4322
Country	:	US
Telephone Number	:	985-722-2860
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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Directions to “ JESSICA RUTH SMITH ” Practice Location

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