Provider Demographics
NPI:1700395316
Name:LAFFERTY, JESSICA ERIN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14325 W 116TH ST APT 2524
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3788
Mailing Address - Country:US
Mailing Address - Phone:573-429-4208
Mailing Address - Fax:
Practice Address - Street 1:3715 W 133RD ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-3347
Practice Address - Country:US
Practice Address - Phone:191-394-8422
Practice Address - Fax:913-948-4223
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-15-20668OtherBEHAVIOR ANALYST CERTIFICATION BOARD
KS013OtherBEHAVIORAL SCIENCES REGULATORY BOARD