Provider Demographics
NPI:1578842589
Name:SCHWALM, JEDEDIAH ANDREW (MED, BCBA)
Entity type:Individual
Prefix:
First Name:JEDEDIAH
Middle Name:ANDREW
Last Name:SCHWALM
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1604
Mailing Address - Country:US
Mailing Address - Phone:207-701-1589
Mailing Address - Fax:
Practice Address - Street 1:3 CROSS ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1604
Practice Address - Country:US
Practice Address - Phone:207-701-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst