Provider Demographics
NPI:1891254181
Name:SAWYER, JESSICA C (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:C
Last Name:SAWYER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:C
Other - Last Name:SWEETEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 N WOOD ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2766
Mailing Address - Country:US
Mailing Address - Phone:708-724-2852
Mailing Address - Fax:
Practice Address - Street 1:5521 W LINCOLN HWY STE 101
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1118
Practice Address - Country:US
Practice Address - Phone:219-359-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-22-63296103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty