MEDICARE: JILLIANNE VISAGGIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BEH-001905	AZ
2	103K00000X	Behavior Analyst	0133002782	VA

General Provider Information

NPI Number	:	1598322323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIANNE VISAGGIO

Provider Business Mailing Address
First Line	:	3001 SLUSHER RD APT 302
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-0168
Country	:	US
Telephone Number	:	973-919-2616
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 S AVENUE 3 E
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-5512
Country	:	US
Telephone Number	:	480-745-1499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/26/2026

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Directions to “ JILLIANNE VISAGGIO ” Practice Location

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