Healthcare Provider Details

I. General information

NPI: 1093008435
Provider Name (Legal Business Name): JESSICA CONNELLY KUYKENDALL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BUXTON LN
BOYNTON BEACH FL
33426-7641
US

IV. Provider business mailing address

17 BUXTON LN
BOYNTON BEACH FL
33426-7641
US

V. Phone/Fax

Practice location:
  • Phone: 561-906-7176
  • Fax:
Mailing address:
  • Phone: 561-906-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8180
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: