Provider Demographics
NPI:1407185291
Name:IRISH, JESSICA ANN (BCBA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANN
Last Name:IRISH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:853 VALLEY CIRCLE DR
Mailing Address - Street 2:APT 101
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1451
Mailing Address - Country:US
Mailing Address - Phone:269-870-5665
Mailing Address - Fax:
Practice Address - Street 1:4201 VARSITY DR
Practice Address - Street 2:SUITE C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5005
Practice Address - Country:US
Practice Address - Phone:734-926-0740
Practice Address - Fax:734-369-8851
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-08-4391103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst