Healthcare Provider Details

I. General information

NPI: 1184118036
Provider Name (Legal Business Name): JESSICA JAGER BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16085 CAMERON WAY
BROOMFIELD CO
80023-8118
US

IV. Provider business mailing address

931 10TH ST STE 776
MODESTO CA
95354-2305
US

V. Phone/Fax

Practice location:
  • Phone: 832-489-3172
  • Fax:
Mailing address:
  • Phone: 832-489-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49120
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: