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NPI Code Detail

MEDICARE: JESSICA WYNKOOP

MEDICARE: JESSICA WYNKOOP
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst0133001823VA

General Provider Information

NPI Number : 1821517210
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA WYNKOOP
Provider Business Mailing Address
First Line : 131 ELDEN ST STE 302
Second Line :
City : HERNDON
State : VA
Zip : 20170-4851
Country : US
Telephone Number : 571-510-5237
Fax Number :
Provider Business Practice Location Address
First Line : 131 ELDEN ST STE 302
Second Line :
City : HERNDON
State : VA
Zip : 20170-4851
Country : US
Telephone Number : 703-496-4371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2017
Last Update Date : 05/05/2026

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Directions to “ JESSICA WYNKOOP ” Practice Location

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