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NPI Code Detail

MEDICARE: JESSICA GAULIN LBS

MEDICARE: JESSICA GAULIN LBS
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 AnalystBH007658PA

General Provider Information

NPI Number : 1902791817
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA GAULIN LBS
Provider Business Mailing Address
First Line : 200 FOREST DR
Second Line :
City : WILMINGTON
State : DE
Zip : 19804-2316
Country : US
Telephone Number : 610-955-8416
Fax Number :
Provider Business Practice Location Address
First Line : 1059 BRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19124-1824
Country : US
Telephone Number : 267-225-7180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2025
Last Update Date : 06/11/2025

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