Provider Demographics
NPI:1225693120
Name:HERSHBERGER, JESSICA ROSE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:HERSHBERGER
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:PO BOX 859
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-0859
Mailing Address - Country:US
Mailing Address - Phone:360-915-6868
Mailing Address - Fax:360-547-6470
Practice Address - Street 1:1890 BARNES BLVD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-1435
Practice Address - Country:US
Practice Address - Phone:360-915-6868
Practice Address - Fax:360-547-6470
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61520372103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst