Provider Demographics
NPI:1568915692
Name:RIMES, JESSICA LEEANN (MSPECED BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEEANN
Last Name:RIMES
Suffix:
Gender:F
Credentials:MSPECED BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEEANN
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPECED BCBA
Mailing Address - Street 1:3201 STELLHORN RD STE I148
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4697
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:3201 STELLHORN RD STE I148
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4697
Practice Address - Country:US
Practice Address - Phone:855-324-0885
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-17-27052103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
14107084OtherCAQH
IN300038435Medicaid
CA1-17-27052OtherBACB CERTIFICATION