Healthcare Provider Details

I. General information

NPI: 1336581677
Provider Name (Legal Business Name): JESSICA WALDMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SAINT GEORGE SQUARE CT STE 300
WINSTON SALEM NC
27103-1368
US

IV. Provider business mailing address

306 SUMMIT ST
ASHEVILLE NC
28803-2725
US

V. Phone/Fax

Practice location:
  • Phone: 336-360-3798
  • Fax:
Mailing address:
  • Phone: 828-236-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49327
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10001343
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1683
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: