Provider Demographics
NPI:1982099578
Name:RICKETTS, JASMINE L (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:L
Last Name:RICKETTS
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 1:4022 LANDHERR DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4470
Mailing Address - Country:US
Mailing Address - Phone:502-417-3778
Mailing Address - Fax:
Practice Address - Street 1:700 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3082
Practice Address - Country:US
Practice Address - Phone:812-288-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst