Healthcare Provider Details

I. General information

NPI: 1114861705
Provider Name (Legal Business Name): JESSICA BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E DELAWARE AVE
REDLANDS CA
92374-2358
US

IV. Provider business mailing address

150 E DELAWARE AVE
REDLANDS CA
92374-2358
US

V. Phone/Fax

Practice location:
  • Phone: 909-408-0121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: