MEDICARE: JESSIKA RAYE IZZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1073155727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIKA RAYE IZZO

Provider Business Mailing Address
First Line	:	1398 PAGE ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15233-2007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1398 PAGE ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15233-2007
Country	:	US
Telephone Number	:	412-335-7584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	10/15/2019

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Directions to “ JESSIKA RAYE IZZO ” Practice Location

Language	Start Address	Practice Location

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