Provider Demographics
NPI:1235666116
Name:RATAJCZAK, JESSICA H
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:H
Last Name:RATAJCZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 KOKOMO DR APT 714
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1824
Mailing Address - Country:US
Mailing Address - Phone:916-903-6882
Mailing Address - Fax:
Practice Address - Street 1:4800 KOKOMO DR APT 714
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1824
Practice Address - Country:US
Practice Address - Phone:916-903-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician