Provider Demographics
NPI:1326878356
Name:AYALA, JISSELLE
Entity type:Individual
Prefix:
First Name:JISSELLE
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 WALL ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-7983
Mailing Address - Country:US
Mailing Address - Phone:608-467-4834
Mailing Address - Fax:
Practice Address - Street 1:5325 WALL ST STE 1000
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-7983
Practice Address - Country:US
Practice Address - Phone:608-467-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician