Healthcare Provider Details

I. General information

NPI: 1588394456
Provider Name (Legal Business Name): JESSICA ANNE DONNELL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 DEVELOPMENT DR
LANSING MI
48911-4213
US

IV. Provider business mailing address

1525 RIDGEWOOD DR
MIDLAND MI
48642-6425
US

V. Phone/Fax

Practice location:
  • Phone: 517-706-0421
  • Fax:
Mailing address:
  • Phone: 989-835-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401002361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: