Individual
JESSICA JAMES DEFORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6858 SWINNEA RD BLDG 6B, SOUTHAVEN, MS 38671-9493
(662) 426-6136
Mailing address
1493 BAKER RD, LAKE CORMORANT, MS 38641-9727
(662) 292-2252
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
TN
Other
Enumeration date
12/04/2018
Last updated
09/10/2024
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