Healthcare Provider Details

I. General information

NPI: 1174857056
Provider Name (Legal Business Name): JESSICA LYNN DONNELLY PHD., BCBA-D, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18521 E QUEEN CREEK RD STE 105-627
QUEEN CREEK AZ
85142-5870
US

IV. Provider business mailing address

9702 EAST COUNTRY PLACE
PALOMINAS AZ
85615
US

V. Phone/Fax

Practice location:
  • Phone: 480-361-1025
  • Fax: 480-814-7488
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000041
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: