Provider Demographics
NPI:1124546239
Name:AIKENS, JESSICA DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:AIKENS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DANIELLE
Other - Last Name:AIKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:P.O BOX 20310
Mailing Address - Street 2:PNB 55984
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7007
Mailing Address - Country:US
Mailing Address - Phone:307-212-3284
Mailing Address - Fax:
Practice Address - Street 1:1050 N 3RD ST STE I
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2543
Practice Address - Country:US
Practice Address - Phone:307-212-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-18-31348103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1124546239Medicaid