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General NPI Number Information
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NPI Number | 1073850327
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Entity Type | Individual
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Provider Name | JESSICA LYN COLON BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 461 WESTFIELD AVE
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City | CLARK
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State | NJ
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Zip | 07066-1733
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Country | US
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Telephone | 908-217-0320
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Fax |
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Provider Business Mailing Address
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Address Line | 461 WESTFIELD AVE
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City | CLARK
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State | NJ
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Zip | 07066-1733
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Country | US
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Telephone | 908-217-0320
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1-08-4878
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License Number State | FL
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