Provider Demographics
NPI:1477028348
Name:OSSE, RONISSA KAYLINN
Entity Type:Individual
Prefix:
First Name:RONISSA
Middle Name:KAYLINN
Last Name:OSSE
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 1:15200 MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5435
Mailing Address - Country:US
Mailing Address - Phone:218-969-7209
Mailing Address - Fax:
Practice Address - Street 1:3610 SNELL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1305
Practice Address - Country:US
Practice Address - Phone:916-654-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNQ2117100549810103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst