Healthcare Provider Details

I. General information

NPI: 1861125023
Provider Name (Legal Business Name): JESSE LEE SEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 S ANKENY BLVD
ANKENY IA
50023-9417
US

IV. Provider business mailing address

2825 S ANKENY BLVD
ANKENY IA
50023-9417
US

V. Phone/Fax

Practice location:
  • Phone: 515-598-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number123009
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: