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NPI Code Detail

MEDICARE: JESSICA MCGOWAN

MEDICARE: JESSICA MCGOWAN
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
1222Q00000XDevelopmental Therapist
2103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811325202
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MCGOWAN
Provider Business Mailing Address
First Line : 6416 NW 5TH WAY
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-6112
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6820 SOUTHPOINT PKWY STE 9
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-6277
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2013
Last Update Date : 08/18/2020

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Directions to “ JESSICA MCGOWAN ” Practice Location

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