Healthcare Provider Details

I. General information

NPI: 1750275533
Provider Name (Legal Business Name): YIJIA JIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 WYDOWN BLVD MSC 85659
ST. LOUIS MO
63105
US

IV. Provider business mailing address

6515 WYDOWN BLVD MSC 85659
ST. LOUIS MO
63105
US

V. Phone/Fax

Practice location:
  • Phone: 425-800-7503
  • Fax:
Mailing address:
  • Phone: 425-800-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: