Provider Demographics
NPI:1841862802
Name:JAMIESON, MIKAELA (BA, MS)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 PAYTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3518
Mailing Address - Country:US
Mailing Address - Phone:661-964-7299
Mailing Address - Fax:
Practice Address - Street 1:9844 RESEARCH DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4381
Practice Address - Country:US
Practice Address - Phone:661-964-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician