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General NPI Number Information
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NPI Number | 1598196156
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Entity Type | Individual
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Provider Name | JESSICA KVASNOK MSW BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 475 S JOHN RODES BLVD
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City | MELBOURNE
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State | FL
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Zip | 32904-1093
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Country | US
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Telephone | 321-241-1170
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Fax | 321-241-1171
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Provider Business Mailing Address
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Address Line | 1427 AURORA RD
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City | MELBOURNE
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State | FL
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Zip | 32935-5315
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Country | US
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Telephone | 321-541-1970
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Fax | 508-222-0503
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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 | 1-13-13299
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License Number State | FL
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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 |
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License Number State |
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