Healthcare Provider Details

I. General information

NPI: 1033975636
Provider Name (Legal Business Name): JESSICA HENNIGAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 S WILLOW ST STE 266
MANCHESTER NH
03103-5751
US

IV. Provider business mailing address

373 S WILLOW ST STE 266
MANCHESTER NH
03103-5751
US

V. Phone/Fax

Practice location:
  • Phone: 877-315-8080
  • Fax:
Mailing address:
  • Phone: 877-315-8080
  • Fax: 405-310-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-328744
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: