Provider Demographics
NPI:1598552580
Name:JET SPECTRUM SERVICES LLC
Entity type:Organization
Organization Name:JET SPECTRUM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-664-0577
Mailing Address - Street 1:16427 82ND AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6825
Mailing Address - Country:US
Mailing Address - Phone:732-664-0577
Mailing Address - Fax:
Practice Address - Street 1:16427 82ND AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6825
Practice Address - Country:US
Practice Address - Phone:732-664-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health