MEDICARE: MS. JESSICA A BROWN 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	1-18-30471

General Provider Information

NPI Number	:	1093201352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA A BROWN BCBA

Provider Business Mailing Address
First Line	:	2919 BREEZEWOOD AVE STE 202
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5283
Country	:	US
Telephone Number	:	910-484-1711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 BREEZEWOOD AVE STE 202
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5283
Country	:	US
Telephone Number	:	910-484-1711
Fax Number	:

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

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	07/10/2018

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