MEDICARE: JAMIE LOREN HERNANDEZ PERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	BACB1148730	WI

General Provider Information

NPI Number	:	1013656651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LOREN HERNANDEZ PERRY

Provider Business Mailing Address
First Line	:	6425 BRIDGE RD APT 205
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53713-1854
Country	:	US
Telephone Number	:	240-614-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	5325 WALL ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53718-7982
Country	:	US
Telephone Number	:	240-614-1992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	02/24/2026

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Directions to “ JAMIE LOREN HERNANDEZ PERRY ” Practice Location

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