Healthcare Provider Details

I. General information

NPI: 1124653977
Provider Name (Legal Business Name): JESSICA LYNN TIGUE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA GANTER

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

IV. Provider business mailing address

4455 N ROCKWELL ST APT 2
CHICAGO IL
60625-3072
US

V. Phone/Fax

Practice location:
  • Phone: 844-244-1818
  • Fax:
Mailing address:
  • Phone: 310-406-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65383
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: