Provider Demographics
NPI:1073021309
Name:WOOTON, JESSICA IRENE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:IRENE
Last Name:WOOTON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 TOWERSIDE TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2235
Mailing Address - Country:US
Mailing Address - Phone:781-467-6227
Mailing Address - Fax:
Practice Address - Street 1:4000 TOWERSIDE TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-2235
Practice Address - Country:US
Practice Address - Phone:781-467-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL1-17-28941103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst