Healthcare Provider Details

I. General information

NPI: 1811522410
Provider Name (Legal Business Name): JESSICA LAUGHLIN PILGRIM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LAUGHLIN BCBA

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 GRASSO PLZ
AFFTON MO
63123-3108
US

IV. Provider business mailing address

4721 S CLIFF AVE STE 103
INDEPENDENCE MO
64055-6969
US

V. Phone/Fax

Practice location:
  • Phone: 636-398-2515
  • Fax: 800-687-5070
Mailing address:
  • Phone: 816-608-1500
  • Fax: 800-687-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-98233
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2021034639
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: