Healthcare Provider Details

I. General information

NPI: 1225507460
Provider Name (Legal Business Name): JESSICA REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE FL 18
PHOENIX AZ
85004-2322
US

IV. Provider business mailing address

17250 GRAND PRIX WAY
MORGAN HILL CA
95037-3726
US

V. Phone/Fax

Practice location:
  • Phone: 801-435-8088
  • Fax:
Mailing address:
  • Phone: 408-607-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68287
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: