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NPI Code Detail

MEDICARE: JESSICA PARKER JACKSON

MEDICARE:   JESSICA PARKER 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 Analyst1-14 -17375CA

General Provider Information

NPI Number : 1699169896
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA PARKER JACKSON
Provider Business Mailing Address
First Line : 2201 E 4TH ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3804
Country : US
Telephone Number : 714-683-5876
Fax Number : 888-420-6257
Provider Business Practice Location Address
First Line : 2201 E 4TH ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3804
Country : US
Telephone Number : 714-683-5876
Fax Number : 888-420-6257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2015
Last Update Date : 11/30/2023

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Directions to “ JESSICA PARKER JACKSON ” Practice Location

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