Healthcare Provider Details

I. General information

NPI: 1801615398
Provider Name (Legal Business Name): JESSA GRACE GARWOOD M.A., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 OFFICE PARK DR
COLUMBIA KY
42728-1381
US

IV. Provider business mailing address

220 OFFICE PARK DR
COLUMBIA KY
42728-1381
US

V. Phone/Fax

Practice location:
  • Phone: 270-250-5070
  • Fax: 270-380-1711
Mailing address:
  • Phone: 270-250-5070
  • Fax: 270-380-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number312171
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number305629
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: