Individual
DEIDRA MARIE FERNSTRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
6040 INTERSTATE 55 NORTH FRONTAGE ROAD, JACKSON, MS 39211
(601) 401-0422
Mailing address
1315 ROBERT DR, JACKSON, MS 39211-6337
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
200041
MS
106E00000X
Assistant Behavior Analyst
201008A
MN
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/21/2018
Last updated
02/17/2026
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