Provider Demographics
NPI:1528303898
Name:BALDWIN, JESSICA ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELIZABETH
Other - Last Name:DORNSEIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:349 YORK RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2660
Mailing Address - Country:US
Mailing Address - Phone:484-477-6587
Mailing Address - Fax:215-657-2927
Practice Address - Street 1:349 YORK RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2660
Practice Address - Country:US
Practice Address - Phone:484-477-6587
Practice Address - Fax:215-657-2927
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-12-12035103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst