Healthcare Provider Details

I. General information

NPI: 1982099578
Provider Name (Legal Business Name): JASMINE L RICKETTS M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MISSOURI AVE
JEFFERSONVILLE IN
47130-3082
US

IV. Provider business mailing address

4022 LANDHERR DR
LOUISVILLE KY
40299-4470
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-4688
  • Fax:
Mailing address:
  • Phone: 502-417-3778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: