Provider Demographics
NPI:1053080127
Name:HUBRICH, JESSICA L (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:HUBRICH
Suffix:
Gender:F
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62643-6049
Mailing Address - Country:US
Mailing Address - Phone:217-671-1414
Mailing Address - Fax:
Practice Address - Street 1:106 N 6TH ST
Practice Address - Street 2:
Practice Address - City:HARTSBURG
Practice Address - State:IL
Practice Address - Zip Code:62643-6049
Practice Address - Country:US
Practice Address - Phone:217-671-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-39874103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-39874OtherBACB