Provider Demographics
NPI:1396996633
Name:CLOUTIER, JESSICA MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:CLOUTIER
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 1:330 CABANA VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5222
Mailing Address - Country:US
Mailing Address - Phone:757-603-5562
Mailing Address - Fax:
Practice Address - Street 1:13553 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225
Practice Address - Country:US
Practice Address - Phone:866-610-0580
Practice Address - Fax:407-588-6294
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst