Provider Demographics
NPI:1316555626
Name:JAGGERS, JOSHUA (BS, MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:JAGGERS
Suffix:
Gender:
Credentials:BS, MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41820 SIX MILE ROAD
Mailing Address - Street 2:BUILDING E SUITE 101
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2772
Mailing Address - Country:US
Mailing Address - Phone:734-239-8931
Mailing Address - Fax:
Practice Address - Street 1:41820 SIX MILE ROAD
Practice Address - Street 2:BUILDING E SUITE 101
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168
Practice Address - Country:US
Practice Address - Phone:734-239-8931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI7401002349103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician