Provider Demographics
NPI:1083367072
Name:BROWN, JESSICA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 WOODHOLLOW DR APT 204
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3948
Mailing Address - Country:US
Mailing Address - Phone:314-299-5713
Mailing Address - Fax:
Practice Address - Street 1:650 OFFICE PKWY
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7103
Practice Address - Country:US
Practice Address - Phone:314-395-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022003501103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst