Individual provider Active NPI

Jessica Gustafson, MA., BCBA

  • Behavior Analyst
  • Raleigh, NC
National Provider Identifier
1265349443
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
3200 Spring Forest Rd Ste 206
Raleigh, NC 27616-2812
Phone
(919) 457-4453
NPI assigned
Aug 25, 2026
Last updated
Aug 25, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X NC Primary

Addresses

Primary practice location

3200 Spring Forest Rd Ste 206
Raleigh, NC 27616-2812

Mailing address

4614 Riverwood Cir Apt 1109
Apt 1109
Raleigh, NC 27612-5783
Phone (732) 484-0358

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": "1787616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1265349443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4614 RIVERWOOD CIR APT 1109",
            "address_2": "APT 1109",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125783",
            "telephone_number": "732-484-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 SPRING FOREST RD STE 206",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276162812",
            "telephone_number": "919-457-4453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "JESSICA",
        "credential": "MA., BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-08-25",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.