Individual
JESSICA BUNDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
221 W ARGYLE ST APT 14, HAGERMAN, NM 88232-9407
(575) 513-5671
Mailing address
PO BOX 34, HAGERMAN, NM 88232-0034
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3282928234
—
NM
Enumeration date
01/25/2017
Last updated
01/25/2017
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