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NPI Code Detail

MEDICARE: JESSICA WROBLE MA, BCBA

MEDICARE: JESSICA WROBLE MA, 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
1103K00000XBehavior Analyst12041688

General Provider Information

NPI Number : 1861015273
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA WROBLE MA, BCBA
Provider Business Mailing Address
First Line : 4 MILL RUN CT
Second Line :
City : MEDFORD
State : NJ
Zip : 08055-2436
Country : US
Telephone Number : 609-440-5792
Fax Number :
Provider Business Practice Location Address
First Line : 4 MILL RUN CT
Second Line :
City : MEDFORD
State : NJ
Zip : 08055-2436
Country : US
Telephone Number : 609-440-5792
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2020
Last Update Date : 05/20/2020

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