Provider Demographics
NPI:1942774450
Name:CLOUGH-MEDORA, JAYSEN (BCBA)
Entity Type:Individual
Prefix:
First Name:JAYSEN
Middle Name:
Last Name:CLOUGH-MEDORA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1255 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3220
Mailing Address - Country:US
Mailing Address - Phone:844-234-8387
Mailing Address - Fax:856-429-4755
Practice Address - Street 1:311 WALTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9579
Practice Address - Country:US
Practice Address - Phone:844-234-8387
Practice Address - Fax:856-429-4755
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst