Jacque Wiswell, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

11212147 Issued in CA

Practice address

370 W Sierra Madre Blvd
Suite B
Sierra Madre, CA 91024-2354

Phone

(626) 355-5160

Fax

(626) 355-5173

NPI assigned

Apr 30, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacque Rabino Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Sierra Madre Learning Center Total Programs, LLC

  • Behavior Analyst
  • Sierra Madre, CA
  • NPI 1578829370
  NPD (past)

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367280000000",
    "number": "1669817060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 S SHELTON ST",
            "address_2": "UNIT C",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915063157",
            "telephone_number": "209-607-0830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 W SIERRA MADRE BLVD",
            "address_2": "SUITE B",
            "city": "SIERRA MADRE",
            "state": "CA",
            "postal_code": "910242354",
            "telephone_number": "626-355-5160",
            "fax_number": "626-355-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISWELL",
        "first_name": "JACQUE",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-30",
        "last_updated": "2013-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "11212147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUE",
            "last_name": "RABINO",
            "credential": "BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Analyst in Sierra Madre, CA
• Providers in Sierra Madre, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; 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.