Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacquavious Deshawn Burt

Individual provider Behavior Technician · NPI 1205564440

Jacquavious Deshawn Burt is a Behavior Technician in Bridgeport, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2022

Practice location Address checks out

6296 Bridgeport Village Square Dr Ste 2
Bridgeport, MI 48722-9655
Phone: (989) 401-1239
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X · Licence 630356139055 (MI)

Record details

NPI number1205564440
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 14, 2022
Last updated in NPPESAugust 14, 2022
Certification dateAugust 14, 2022

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