Provider Demographics
NPI:1093170680
Name:JANSMA, JESSA (BCBA)
Entity Type:Individual
Prefix:
First Name:JESSA
Middle Name:
Last Name:JANSMA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 GALILEE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6939
Mailing Address - Country:US
Mailing Address - Phone:916-698-4414
Mailing Address - Fax:916-729-3006
Practice Address - Street 1:6400 TUPELO DR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:95621
Practice Address - Country:UM
Practice Address - Phone:916-729-3098
Practice Address - Fax:916-729-3006
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11518909103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst