MEDICARE: JESSICA PARKER M.A., BCBA, LBA

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	628

General Provider Information

NPI Number	:	1417434580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PARKER M.A., BCBA, LBA

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 TENNESSEE WAY STE 400
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3160
Country	:	US
Telephone Number	:	629-255-0339
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	11/14/2025

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