Provider Demographics
NPI:1336945104
Name:ZAWACKI, JESSICA M (PHD BCBA)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:M
Last Name:ZAWACKI
Suffix:
Gender:
Credentials:PHD BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1016
Mailing Address - Country:US
Mailing Address - Phone:610-220-1245
Mailing Address - Fax:
Practice Address - Street 1:542 AMHERST ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1016
Practice Address - Country:US
Practice Address - Phone:610-220-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1804103K00000X
PABH005429103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst