Healthcare Provider Details

I. General information

NPI: 1225693120
Provider Name (Legal Business Name): JESSICA ROSE HERSHBERGER BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19134 JOSELYN ST SW
ROCHESTER WA
98579-9217
US

IV. Provider business mailing address

19134 JOSELYN ST SW
ROCHESTER WA
98579-9217
US

V. Phone/Fax

Practice location:
  • Phone: 541-829-3185
  • Fax:
Mailing address:
  • Phone: 541-829-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61520372
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: