Provider Demographics
NPI:1285117333
Name:DEMEUSE, JESSICA JUNE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JUNE
Last Name:DEMEUSE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 WIGGINS WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7263
Mailing Address - Country:US
Mailing Address - Phone:920-495-6191
Mailing Address - Fax:
Practice Address - Street 1:986 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-8818
Practice Address - Country:US
Practice Address - Phone:920-544-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1-18-31062103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst