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NPI Code Detail

MEDICARE: MISS SHAYLEE BREANNE JACKSON

MEDICARE: MISS SHAYLEE BREANNE JACKSON
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 AnalystBH008453PA

General Provider Information

NPI Number : 1447984950
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SHAYLEE BREANNE JACKSON
Provider Business Mailing Address
First Line : 147 W JOHN ST APT 3
Second Line :
City : BEDFORD
State : PA
Zip : 15522-1720
Country : US
Telephone Number : 304-702-2420
Fax Number :
Provider Business Practice Location Address
First Line : 147 W JOHN ST APT 3
Second Line :
City : BEDFORD
State : PA
Zip : 15522-1720
Country : US
Telephone Number : 304-702-2420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2022
Last Update Date : 04/30/2026

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Directions to “ MISS SHAYLEE BREANNE JACKSON ” Practice Location

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