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General NPI Number Information
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NPI Number | 1679435705
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Entity Type | Individual
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Provider Name | JESSICA MARIE DAVIS
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Gender | Female
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 79 WINSTON DR STE 229
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-5775
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Country | US
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Telephone | 307-212-3284
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Fax |
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Provider Business Mailing Address
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Address Line | 4009 MADISON DR APT 12B
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4412
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Country | US
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Telephone | 307-354-8469
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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 | RBT-25-494372
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License Number State | WY
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