Active NPI
Jessica Lynn Bracken, BCBA
- Behavior Analyst
- Roseville, MN
National Provider Identifier
1629709951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1007140
- Practice address
- 3030 Centre Pointe Dr # 90
Roseville, MN 55113-1112 - Phone
- (651) 461-2022
- NPI assigned
- Jun 17, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Behavior Analyst | 103K00000X | 1007140 | WI | Primary |
Addresses
Primary practice location
3030 Centre Pointe Dr # 90
Roseville, MN 55113-1112
Mailing address
211 Deer Path
Stillwater, MN 55082-5384
Phone (715) 797-8902
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1007140 | WI | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743984000000",
"number": "1629709951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 DEER PATH",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550825384",
"telephone_number": "715-797-8902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3030 CENTRE POINTE DR # 90",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551131112",
"telephone_number": "651-461-2022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKEN",
"first_name": "JESSICA",
"middle_name": "LYNN",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-17",
"last_updated": "2025-04-07",
"certification_date": "2025-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WI",
"license": "1007140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.