Provider Demographics
NPI:1457014235
Name:KURTZ, JESSICA R (RBT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:KURTZ
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 1:1051 SR 311 TRLR 65
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-1239
Mailing Address - Country:US
Mailing Address - Phone:816-372-4858
Mailing Address - Fax:
Practice Address - Street 1:1051 SR 311 TRLR 65
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-1239
Practice Address - Country:US
Practice Address - Phone:816-372-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty