Provider Demographics
NPI:1710217963
Name:REESE, JESSICA ELLYN (BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELLYN
Last Name:REESE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:8801 E COLETTE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2633
Mailing Address - Country:US
Mailing Address - Phone:520-282-0692
Mailing Address - Fax:520-721-0069
Practice Address - Street 1:8801 E COLETTE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2633
Practice Address - Country:US
Practice Address - Phone:520-282-0692
Practice Address - Fax:520-721-0069
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-07-3388103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst