Provider Demographics
NPI:1376848184
Name:BALDRIDGE, JESSICA JAMES (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JAMES
Last Name:BALDRIDGE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7537
Mailing Address - Country:US
Mailing Address - Phone:972-743-0044
Mailing Address - Fax:
Practice Address - Street 1:414 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-7537
Practice Address - Country:US
Practice Address - Phone:972-743-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-09-5145103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst