Provider Demographics
NPI:1770155277
Name:MACGINNIS, JESSICA W (BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:W
Last Name:MACGINNIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1826 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4569
Mailing Address - Country:US
Mailing Address - Phone:386-561-7244
Mailing Address - Fax:
Practice Address - Street 1:3408 SOUTH ATLANTIC AVE
Practice Address - Street 2:PMB 1052
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118
Practice Address - Country:US
Practice Address - Phone:386-767-3752
Practice Address - Fax:386-767-4319
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-23-65773103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician