Provider Demographics
NPI:1609699446
Name:LILLIBRIDGE, JESSICA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LILLIBRIDGE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 W LANE RD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1625
Mailing Address - Country:US
Mailing Address - Phone:815-655-7989
Mailing Address - Fax:
Practice Address - Street 1:1205 W LANE RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1625
Practice Address - Country:US
Practice Address - Phone:815-655-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-24-76990103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst