MEDICARE: JELENA TICA

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	:	1477065811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JELENA TICA

Provider Business Mailing Address
First Line	:	3120 STONEGATE DR
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-8814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 STONEGATE DR
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-8814
Country	:	US
Telephone Number	:	530-788-5482
Fax Number	:

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

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	10/25/2017

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Directions to “ JELENA TICA ” Practice Location

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