Provider Demographics
NPI:1851951057
Name:SHEAFFER, JESSALYN NICOLE
Entity Type:Individual
Prefix:
First Name:JESSALYN
Middle Name:NICOLE
Last Name:SHEAFFER
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 1:22506 NORTON CT
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5442
Mailing Address - Country:US
Mailing Address - Phone:907-887-1230
Mailing Address - Fax:
Practice Address - Street 1:16941 N EAGLE RIVER LOOP RD STE 3
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7824
Practice Address - Country:US
Practice Address - Phone:907-726-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBTOtherAPPLIED BEHAVIOR ANALYSIS