Healthcare Provider Details

I. General information

NPI: 1568948958
Provider Name (Legal Business Name): JESSICA E HALL BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 WAVERLY ROAD
HUNTINGTON WV
25704
US

IV. Provider business mailing address

4614 WAVERLY RD
HUNTINGTON WV
25704-1039
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-3287
  • Fax: 304-429-0024
Mailing address:
  • Phone: 304-429-3287
  • Fax: 304-429-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-18-8873
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: