Provider Demographics
NPI:1730742180
Name:REYES, JESSICA (BA / RBT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:BA / RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 MANIAGO DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-3883
Mailing Address - Country:US
Mailing Address - Phone:209-559-0861
Mailing Address - Fax:
Practice Address - Street 1:5641 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-1928
Practice Address - Country:US
Practice Address - Phone:209-559-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician