Provider Demographics
NPI:1457040271
Name:JASECKAS, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:JASECKAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 SPRING JOG ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-8079
Mailing Address - Country:US
Mailing Address - Phone:435-709-1780
Mailing Address - Fax:
Practice Address - Street 1:6430 SPRING JOG ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-8079
Practice Address - Country:US
Practice Address - Phone:702-908-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst