1740517432 NPI number — MRS. JESSICA L. SPIES MS, BCBA

Table of content: MRS. JESSICA L. SPIES MS, BCBA (NPI 1740517432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740517432 NPI number — MRS. JESSICA L. SPIES MS, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPIES
Provider First Name:
JESSICA
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUGH
Provider Other First Name:
JESSICA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740517432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7065 OAKCREEK TRCE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMMING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30041-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-787-5826
Provider Business Mailing Address Fax Number:
678-456-5095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7065 OAKCREEK TRCE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-787-5826
Provider Business Practice Location Address Fax Number:
678-456-5095
Provider Enumeration Date:
11/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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