Provider Demographics
NPI:1790552297
Name:GONZALEZ-LEDESMA, JESSICA (RBT-23-306410)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GONZALEZ-LEDESMA
Suffix:
Gender:F
Credentials:RBT-23-306410
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18540 NW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2501
Mailing Address - Country:US
Mailing Address - Phone:305-952-0530
Mailing Address - Fax:
Practice Address - Street 1:18540 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2501
Practice Address - Country:US
Practice Address - Phone:305-952-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician