MEDICARE: MRS. JESSICA L BERGERON MA, 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
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1598368722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA L BERGERON MA, BCBA, LBA

Provider Business Mailing Address
First Line	:	535 S EDISON AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3976
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	876 HORACE BROWN DR
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1862
Country	:	US
Telephone Number	:	248-965-3916
Fax Number	:

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

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	05/05/2026

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