Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-13-14748 | CA |
NPI | 1013347715 |
---|---|
Provider Name | Jessica Vedder |
First Address | Irvine, CA 92606-9928 |
Second Address | Fresno, CA 93710-8600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2013 |
Last Update Date | 11/10/2019 |