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General NPI Number Information
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NPI Number | 1316835994
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Entity Type | Individual
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Provider Name | JESSICA LYNN STEVENSON
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 359 TOWNE CENTER BLVD
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City | RIDGELAND
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State | MS
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Zip | 39157-4868
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Country | US
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Telephone | 769-233-7154
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Fax | 601-398-0364
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Provider Business Mailing Address
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Address Line | 402B LEGACY PARK
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City | RIDGELAND
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State | MS
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Zip | 39157-4315
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Country | US
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Telephone | 769-233-7154
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Fax | 601-398-0364
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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 | 1356646
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License Number State | MS
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