Provider Demographics
NPI:1982144952
Name:JANUSCH, JESSICA JOHANNA (MS, LLP, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOHANNA
Last Name:JANUSCH
Suffix:
Gender:F
Credentials:MS, LLP, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30821 BARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1871
Mailing Address - Country:US
Mailing Address - Phone:734-355-2833
Mailing Address - Fax:248-331-9919
Practice Address - Street 1:30821 BARRINGTON ST
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1871
Practice Address - Country:US
Practice Address - Phone:734-355-2833
Practice Address - Fax:248-331-9919
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11833171103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst