Provider Demographics
NPI:1790408110
Name:NAQUIN, JESSICA APRYL (RBT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:APRYL
Last Name:NAQUIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:APRYL
Other - Last Name:NIETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3416 S DIXON RD STE B
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-5644
Mailing Address - Country:US
Mailing Address - Phone:765-252-6173
Mailing Address - Fax:
Practice Address - Street 1:3416 S DIXON RD STE B
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-5644
Practice Address - Country:US
Practice Address - Phone:765-252-6173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
INRBT-20-126508OtherBEHAVIOR ANALYST CERTIFICATION BOARD