Provider Demographics
NPI:1104577733
Name:RISMILLER, JESSICA LEE (BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:RISMILLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-1044
Mailing Address - Country:US
Mailing Address - Phone:707-498-5799
Mailing Address - Fax:
Practice Address - Street 1:875 CRESCENT WAY
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6741
Practice Address - Country:US
Practice Address - Phone:707-498-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-56613103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst