Provider Demographics
NPI:1285915538
Name:JOWETT HIRST, ERICA STEPHANIE (PHD, BCBA-D, LBA)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:STEPHANIE
Last Name:JOWETT HIRST
Suffix:
Gender:F
Credentials:PHD, BCBA-D, LBA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:STEPHANIE
Other - Last Name:SEVERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:338 BROADWAY ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-7331
Mailing Address - Country:US
Mailing Address - Phone:469-298-8113
Mailing Address - Fax:
Practice Address - Street 1:338 BROADWAY ST STE 301
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-7331
Practice Address - Country:US
Practice Address - Phone:469-298-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-08-4514103K00000X
TX2639103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst