Active NPI
Jessica Russell
- Behavior Technician
- Riverbank, CA
National Provider Identifier
1184445249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 5501 Antique Rose Way
Riverbank, CA 95367-9505 - Phone
- (866) 523-4268
- NPI assigned
- Oct 22, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
5501 Antique Rose Way
Riverbank, CA 95367-9505
Mailing address
850 Towbin Ave
Lakewood, NJ 08701-5928
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729555200000",
"number": "1184445249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 TOWBIN AVE",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087015928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5501 ANTIQUE ROSE WAY",
"city": "RIVERBANK",
"state": "CA",
"postal_code": "953679505",
"telephone_number": "866-523-4268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-22",
"last_updated": "2024-10-22",
"certification_date": "2024-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.