Healthcare Provider Details

I. General information

NPI: 1295650349
Provider Name (Legal Business Name): JESSIE EAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE HAGOOD

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 COLLYER ST
LONGMONT CO
80501-3310
US

IV. Provider business mailing address

1333 COLLYER ST
LONGMONT CO
80501-3310
US

V. Phone/Fax

Practice location:
  • Phone: 303-776-7117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: