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NPI Code Detail

MEDICARE: JESSICA RAE LUDEKER

MEDICARE: JESSICA RAE LUDEKER
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1235708272
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RAE LUDEKER
Provider Business Mailing Address
First Line : 1040 N 10TH ST STE 100
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-6150
Country : US
Telephone Number : 844-263-1613
Fax Number :
Provider Business Practice Location Address
First Line : 1040 N 10TH ST STE 100
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-6150
Country : US
Telephone Number : 844-263-1613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2021
Last Update Date : 08/08/2023

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Directions to “ JESSICA RAE LUDEKER ” Practice Location

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