Healthcare Provider Details

I. General information

NPI: 1699601682
Provider Name (Legal Business Name): ALEESA BLACKBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44028 4TH ST E
LANCASTER CA
93535-3613
US

IV. Provider business mailing address

44028 4TH ST E
LANCASTER CA
93535-3613
US

V. Phone/Fax

Practice location:
  • Phone: 661-877-2878
  • Fax:
Mailing address:
  • Phone: 661-877-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberY6628577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: