Provider Demographics
NPI:1588915185
Name:CONEDY, JESSICA LYNN (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:CONEDY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:CARVALHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:1155 KELLY JOHNSON BLVD STE. 150
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-354-2582
Mailing Address - Fax:720-493-4632
Practice Address - Street 1:1155 KELLY JOHNSON BLVD STE. 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-354-2582
Practice Address - Fax:720-493-4632
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-12-11883103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46473041Medicaid