MEDICARE: JESSICA M TONDREAU BCBA

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	103K00000X	Behavior Analyst	1-21-49559	CO
2	103K00000X	Behavior Analyst	7401001736	MI
3	156F00000X	Technician/Technologist

General Provider Information

NPI Number	:	1033636220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M TONDREAU BCBA

Provider Business Mailing Address
First Line	:	PO BOX 419885
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-9885
Country	:	US
Telephone Number	:	194-294-4050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 S MAIN ST STE 3
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-4309
Country	:	US
Telephone Number	:	517-312-1710
Fax Number	:

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

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	07/21/2022

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Directions to “ JESSICA M TONDREAU BCBA” Practice Location

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