Provider Demographics
NPI:1902181787
Name:REDDI, CLARISSA L (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:L
Last Name:REDDI
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 B ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-1639
Mailing Address - Country:US
Mailing Address - Phone:402-984-0459
Mailing Address - Fax:
Practice Address - Street 1:1944 B ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-1639
Practice Address - Country:US
Practice Address - Phone:402-984-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE0-08-2615103K00000X
1-12-12430103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst