Provider Demographics
NPI:1972333516
Name:RAWLINS, JESSIE LYIN
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:LYIN
Last Name:RAWLINS
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 1:1200 BUNN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5343
Mailing Address - Country:US
Mailing Address - Phone:217-200-5710
Mailing Address - Fax:
Practice Address - Street 1:6405 MCINTOSH CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6815
Practice Address - Country:US
Practice Address - Phone:217-200-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician