MEDICARE: JESSICA HUBBARD

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	BH006075	PA

General Provider Information

NPI Number	:	1437028651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HUBBARD

Provider Business Mailing Address
First Line	:	35 HILLTOP DR
Second Line	:
City	:	TUNKHANNOCK
State	:	PA
Zip	:	18657-6605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 WELLES ST STE 120
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4969
Country	:	US
Telephone Number	:	833-867-8371
Fax Number	:	412-368-2701

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

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	11/04/2025

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