Provider Demographics
NPI:1740517432
Name:SPIES, JESSICA L (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:SPIES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:7065 OAKCREEK TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-3405
Mailing Address - Country:US
Mailing Address - Phone:678-787-5826
Mailing Address - Fax:678-456-5095
Practice Address - Street 1:7065 OAKCREEK TRCE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3405
Practice Address - Country:US
Practice Address - Phone:678-787-5826
Practice Address - Fax:678-456-5095
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst