Healthcare Provider Details

I. General information

NPI: 1851876940
Provider Name (Legal Business Name): CRISSY STARR JACKSON BCBA, LBA, IBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CRISSY STARR RYUN

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 MONROVIA ST STE 310
LENEXA KS
66215-3500
US

IV. Provider business mailing address

8700 MONROVIA ST STE 310
LENEXA KS
66215-3500
US

V. Phone/Fax

Practice location:
  • Phone: 913-443-6877
  • Fax:
Mailing address:
  • Phone: 913-443-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1811089014
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: