Provider Demographics
NPI:1053827063
Name:JEFFERS, VANESSA BREANN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:BREANN
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:BREANN- BAEKER
Other - Last Name:COPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4251 S HIGUERA ST STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7736
Mailing Address - Country:US
Mailing Address - Phone:805-541-7130
Mailing Address - Fax:805-541-7131
Practice Address - Street 1:4251 S HIGUERA ST STE 800
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7736
Practice Address - Country:US
Practice Address - Phone:805-541-7130
Practice Address - Fax:805-541-7131
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-29053103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst