MEDICARE: JESSICA MCALLISTER

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	:	1821658121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MCALLISTER

Provider Business Mailing Address
First Line	:	3501 BLAKE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-4888
Country	:	US
Telephone Number	:	720-524-3975
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 BLAKE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-4888
Country	:	US
Telephone Number	:	720-524-3975
Fax Number	:

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

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	08/16/2022

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