Provider Demographics
NPI:1346814308
Name:REED, JESSICA DANIELE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DANIELE
Last Name:REED
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:DANIELE
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 W UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-6982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-6982
Practice Address - Country:US
Practice Address - Phone:321-674-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician