Jessica Ann Boller, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-38095 Issued in CA

Practice address

15 Calle Alumbrado
San Clemente, CA 92673-6709

Phone

(949) 682-9557

NPI assigned

Jun 24, 2019

Last updated

Oct 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shine Learning Alliance

  • Behavior Analyst
  • Irvine, CA
  • NPI 1508406331
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1326609918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2107 INDIAN SPRINGS LN",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926603617",
            "telephone_number": "714-400-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 CALLE ALUMBRADO",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736709",
            "telephone_number": "949-682-9557"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2102 Business Center Dr",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926121001",
            "country_code": "US",
            "telephone_number": "949-682-9557",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2107 Indian Springs Ln",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926603617",
            "country_code": "US",
            "telephone_number": "949-682-9557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLLER",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-24",
        "last_updated": "2022-10-05",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-19-38095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.