Healthcare Provider Details

I. General information

NPI: 1598322323
Provider Name (Legal Business Name): JILLIANNE VISAGGIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 S AVENUE 3 E
YUMA AZ
85365-5512
US

IV. Provider business mailing address

3001 SLUSHER RD APT 302
SUFFOLK VA
23435-0168
US

V. Phone/Fax

Practice location:
  • Phone: 480-745-1499
  • Fax:
Mailing address:
  • Phone: 973-919-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001905
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002782
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: