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NPI Code Detail

MEDICARE: JESSIE GALLAGHER

MEDICARE: JESSIE GALLAGHER
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

General Provider Information

NPI Number : 1265165534
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSIE GALLAGHER
Provider Business Mailing Address
First Line : 1402 BELMONT STAKES AVE
Second Line :
City : INDIAN TRAIL
State : NC
Zip : 28079-5737
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7504 E INDEPENDENCE BLVD STE 103
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-9407
Country : US
Telephone Number : 888-392-8642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2022
Last Update Date : 12/11/2023

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