Provider Demographics
NPI:1821713124
Name:BROWN, JESSICA (RBT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2583 RUBYVALE RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4619
Mailing Address - Country:US
Mailing Address - Phone:216-906-3345
Mailing Address - Fax:317-534-1188
Practice Address - Street 1:9465 COUNSELORS ROW
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-6423
Practice Address - Country:US
Practice Address - Phone:317-721-8884
Practice Address - Fax:317-534-1188
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty