Provider Demographics
NPI:1669826012
Name:BLACKWELL, JESSICA A
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 N MAIN ST # 80
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1647
Mailing Address - Country:US
Mailing Address - Phone:508-938-9404
Mailing Address - Fax:508-257-7088
Practice Address - Street 1:4171 N MAIN ST # 80
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1647
Practice Address - Country:US
Practice Address - Phone:508-938-9404
Practice Address - Fax:508-257-7088
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst