Individual
MRS. JESICA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
3121 N OAK STREET EXT, VALDOSTA, GA 31602-1099
(800) 832-9419
Mailing address
406 JACKSON CIR, LAKE PARK, GA 31636-4928
(229) 630-2086
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-44103
NM
106S00000X
Behavior Technician
18-57850
UT
Other
Enumeration date
06/12/2018
Last updated
01/06/2022
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