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General NPI Number Information
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NPI Number | 1578113353
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Entity Type | Individual
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Provider Name | JESSICA ANN HERBST
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Gender | Female
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 1112 GALLIA ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4161
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Country | US
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Telephone | 317-674-0981
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Fax |
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Provider Business Mailing Address
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Address Line | 810 DUNAWAY ST
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City | MIAMISBURG
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State | OH
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Zip | 45342-3833
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Country | US
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Telephone | 937-336-7686
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 00977
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 287507
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License Number State | KY
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