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NPI Code Detail

MEDICARE: JESSICA LYNN TIGUE BCBA

MEDICARE: JESSICA LYNN TIGUE 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
1103K00000XBehavior Analyst1-23-65383IL
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1124653977
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN TIGUE BCBA
Provider Business Mailing Address
First Line : 4455 N ROCKWELL ST APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3072
Country : US
Telephone Number : 310-406-7510
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S DOUGLAS RD STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-244-1818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2020
Last Update Date : 06/24/2026

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