Provider Demographics
NPI:1245691336
Name:REISS, JESSICA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REISS
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 1:18217 SANDHURST CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-5601
Mailing Address - Country:US
Mailing Address - Phone:808-226-8487
Mailing Address - Fax:
Practice Address - Street 1:3015 E SKELLY DR STE 395
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6348
Practice Address - Country:US
Practice Address - Phone:918-764-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-18-30075103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst