Individual
JESSICA NICHOLE LAVENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32871 LA HIGHWAY 16 # NA, DENHAM SPRINGS, LA 70706-1316
(225) 349-7960
Mailing address
996 ROYAL MARCO WAY, MARCO ISLAND, FL 34145-1829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
R-21398
LA
Other
Enumeration date
02/10/2025
Last updated
02/10/2025
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