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General NPI Number Information
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NPI Number | 1225526932
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Entity Type | Individual
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Provider Name | JESSE CUSHEN
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Gender | Female
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 365 W 2ND ST
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City | WRAY
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State | CO
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Zip | 80758-1009
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Country | US
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Telephone | 970-332-3133
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Fax | 970-332-3134
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Provider Business Mailing Address
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Address Line | 211 W MAIN ST
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City | STERLING
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State | CO
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Zip | 80751-3168
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Country | US
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Telephone | 970-522-4549
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Fax | 970-522-6898
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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