Provider Demographics
NPI:1386928679
Name:VICK, JESSICA KATHERINE (BS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHERINE
Last Name:VICK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KATHERINE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:280 INTERSTATE NORTH CIR SE SUITE 430
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2450
Mailing Address - Country:US
Mailing Address - Phone:770-956-8511
Mailing Address - Fax:770-956-8907
Practice Address - Street 1:280 INTERSTATE NORTH CIR SE SUITE 430
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2450
Practice Address - Country:US
Practice Address - Phone:770-956-8511
Practice Address - Fax:770-956-8907
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst