Healthcare Provider Details

I. General information

NPI: 1356266282
Provider Name (Legal Business Name): JESSICA KOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 US 9
FREEHOLD NJ
07728-3554
US

IV. Provider business mailing address

3425 US 9
FREEHOLD NJ
07728-3554
US

V. Phone/Fax

Practice location:
  • Phone: 732-243-0098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00335100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: