Provider Demographics
NPI:1902132657
Name:CORDOVA, JESSICA N (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:N
Last Name:CORDOVA
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 1:29715 ROLAND ORCHARD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3131
Mailing Address - Country:US
Mailing Address - Phone:281-702-2368
Mailing Address - Fax:
Practice Address - Street 1:29715 ROLAND ORCHARD CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-3131
Practice Address - Country:US
Practice Address - Phone:281-702-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-09-5811103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst