Individual
JADAE CELESTINE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 CHURCH ST, PHILADELPHIA, PA 19106-2201
(267) 807-0550
Mailing address
1014 N 45TH ST, PHILADELPHIA, PA 19104-1208
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1143042
PA
Other
Enumeration date
03/16/2026
Last updated
03/16/2026
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