Individual
JESSICA ETHEREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., BCBA
Contact information
Practice address
6232 SADDLE WOOD LN, FAIRHOPE, AL 36532-5557
(228) 623-5454
Mailing address
6232 SADDLE WOOD LN, FAIRHOPE, AL 36532-5557
(228) 623-5454
(888) 977-2153
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-09-6490
TX
103K00000X
Behavior Analyst
Primary
2021-028
AL
Other
Enumeration date
05/21/2013
Last updated
07/25/2023
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