Provider Demographics
NPI:1225689136
Name:CORONADO, JESSICA (RBT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12668 SILICON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4171
Mailing Address - Country:US
Mailing Address - Phone:210-239-0099
Mailing Address - Fax:
Practice Address - Street 1:12668 SILICON DR UNIT 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4171
Practice Address - Country:US
Practice Address - Phone:210-239-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst