Provider Demographics
NPI:1366711921
Name:TRAYLOR, JESSICA ELIZABETH (MS AND BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:MS AND BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELIZABETH
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7530 W SAHARA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2793
Mailing Address - Country:US
Mailing Address - Phone:702-260-2360
Mailing Address - Fax:702-822-4484
Practice Address - Street 1:7530 W SAHARA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2793
Practice Address - Country:US
Practice Address - Phone:702-260-2360
Practice Address - Fax:702-822-4484
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBAT042811103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst