Provider Demographics
NPI:1609119114
Name:ISHMAEL, LEE ANNE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LEE ANNE
Middle Name:
Last Name:ISHMAEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923B VIGILANTE AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-3113
Mailing Address - Country:US
Mailing Address - Phone:719-322-1616
Mailing Address - Fax:
Practice Address - Street 1:4152 W SWIFT AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6388
Practice Address - Country:US
Practice Address - Phone:559-724-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0-12-4986103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst