Provider Demographics
NPI:1558040907
Name:ZUNKER, JESSICA (BCABA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ZUNKER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5044
Mailing Address - Country:US
Mailing Address - Phone:864-336-3790
Mailing Address - Fax:
Practice Address - Street 1:301 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3122
Practice Address - Country:US
Practice Address - Phone:864-336-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0-23-14606106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst