Provider Demographics
NPI:1780956482
Name:GIESE, JESSIE (LCSW, BCBA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:GIESE
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 NAPERVILLE WHEATON RD STE 212
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1517
Mailing Address - Country:US
Mailing Address - Phone:630-931-2388
Mailing Address - Fax:
Practice Address - Street 1:1555 NAPERVILLE WHEATON RD STE 212
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1517
Practice Address - Country:US
Practice Address - Phone:630-931-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-14-16116103K00000X
IL149.0183221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1-14-16116OtherBEHAVIOR ANALYST CERTIFICATION BOARD