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NPI 1356095400

NPI 1356095400 : JESSICA PICKETT : BIRMINGHAM, AL

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General NPI Number Information
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    NPI Number           |    1356095400
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    Entity Type          |    Individual 
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    Provider Name        |    JESSICA PICKETT
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    02/08/2022
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    Last Update Date     |    03/10/2023
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Provider Practice Location Address
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    Address Line         |    4778 OVERTON RD 
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    City                 |    BIRMINGHAM
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    State                |    AL
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    Zip                  |    35210-3803
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    Country              |    US
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    Telephone            |    59-570-2942
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    4778 OVERTON RD 
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    City                 |    BIRMINGHAM
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    State                |    AL
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    Zip                  |    35210-3803
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    Country              |    US
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    Telephone            |    205-957-0294
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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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