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General NPI Number Information
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NPI Number | 1609119114
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Entity Type | Individual
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Provider Name | LEE ANNE ISHMAEL BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 4152 W SWIFT AVE STE 104
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City | FRESNO
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State | CA
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Zip | 93722-6388
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Country | US
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Telephone | 559-724-3702
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Fax |
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Provider Business Mailing Address
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Address Line | 2923B VIGILANTE AVE
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City | LEMOORE
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State | CA
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Zip | 93245-3113
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Country | US
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Telephone | 719-322-1616
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0-12-4986
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License Number State | CO
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