Individual
JESSICA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15TH 4TH STREET, MALONE, NY 12955
(518) 651-2780
Mailing address
1100 JERSEY AVE, OGDENSBURG, NY 13669-3514
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14157715
—
NY
Enumeration date
12/27/2021
Last updated
12/27/2021
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