Provider Demographics
NPI:1215075916
Name:HICKS, JESSICA JOY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JOY
Last Name:HICKS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 MADEN DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2212
Mailing Address - Country:US
Mailing Address - Phone:423-483-7005
Mailing Address - Fax:423-220-8231
Practice Address - Street 1:182 MADEN DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-2212
Practice Address - Country:US
Practice Address - Phone:423-483-7005
Practice Address - Fax:423-220-8231
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001839103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst