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General NPI Number Information
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NPI Number | 1073477931
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Entity Type | Individual
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Provider Name | JESSICA WALKER PERKINS
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Gender | Female
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 1011 MEADOWLANDS DR STE 1
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55127-2340
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Country | US
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Telephone | 612-315-1976
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 95TH LN NE
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City | BLAINE
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State | MN
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Zip | 55434-3440
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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