Provider Demographics
NPI:1538829759
Name:JESPERSEN, ALLISON JANINA LYN (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:JANINA LYN
Last Name:JESPERSEN
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 N WHISTLER LN APT 106
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6234
Mailing Address - Country:US
Mailing Address - Phone:805-369-4803
Mailing Address - Fax:
Practice Address - Street 1:1905 S TOPAZ WAY # 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4477
Practice Address - Country:US
Practice Address - Phone:208-518-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty