Healthcare Provider Details

I. General information

NPI: 1083105191
Provider Name (Legal Business Name): JESSICA ALWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 MAITLAND CENTER COMMONS BLVD STE 225
MAITLAND FL
32751-7202
US

IV. Provider business mailing address

876 KILLEARN BLVD
WINTER HAVEN FL
33880-1706
US

V. Phone/Fax

Practice location:
  • Phone: 386-320-5653
  • Fax:
Mailing address:
  • Phone: 863-388-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: