Healthcare Provider Details

I. General information

NPI: 1598368722
Provider Name (Legal Business Name): JESSICA L BERGERON MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

876 HORACE BROWN DR
MADISON HEIGHTS MI
48071-1862
US

IV. Provider business mailing address

535 S EDISON AVE
ROYAL OAK MI
48067-3976
US

V. Phone/Fax

Practice location:
  • Phone: 248-965-3916
  • 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
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: