Provider Demographics
NPI:1578140018
Name:WALDRON SHOVER, JESSICA (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:WALDRON SHOVER
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:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-0699
Mailing Address - Country:US
Mailing Address - Phone:802-424-1042
Mailing Address - Fax:802-448-6905
Practice Address - Street 1:397 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1739
Practice Address - Country:US
Practice Address - Phone:802-424-1042
Practice Address - Fax:802-448-6905
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst