Healthcare Provider Details

I. General information

NPI: 1346694197
Provider Name (Legal Business Name): JESSICA IRELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 PLANTATION PARK DR STE 204
BLUFFTON SC
29910-9008
US

IV. Provider business mailing address

PO BOX 3444
BLUFFTON SC
29910-3444
US

V. Phone/Fax

Practice location:
  • Phone: 843-706-0831
  • Fax: 843-706-0830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88677
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: