Provider Demographics
NPI:1801201280
Name:HEACOCK, JESSICA LYNN (MA BCBA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:HEACOCK
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 PLYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7252
Mailing Address - Country:US
Mailing Address - Phone:386-216-1558
Mailing Address - Fax:
Practice Address - Street 1:1004 HICKORY HILL LN
Practice Address - Street 2:SUITE 2
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1930
Practice Address - Country:US
Practice Address - Phone:615-939-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN75-2690132103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst