Provider Demographics
NPI:1790114254
Name:HERTEL, JESSICA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HERTEL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PALOMAR AIRPORT RD
Mailing Address - Street 2:300
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1027
Mailing Address - Country:US
Mailing Address - Phone:858-226-3246
Mailing Address - Fax:
Practice Address - Street 1:701 PALOMAR AIRPORT RD
Practice Address - Street 2:300
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1027
Practice Address - Country:US
Practice Address - Phone:858-226-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst