Provider Demographics
NPI:1063976553
Name:GIAMMANCHERI, JESSIE KERN (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:KERN
Last Name:GIAMMANCHERI
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2843
Mailing Address - Country:US
Mailing Address - Phone:985-414-2491
Mailing Address - Fax:
Practice Address - Street 1:911 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2843
Practice Address - Country:US
Practice Address - Phone:985-414-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst