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NPI Code Detail

MEDICARE: EMILY NICOLE JIREL

MEDICARE: EMILY NICOLE JIREL
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1558200923
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY NICOLE JIREL
Provider Business Mailing Address
First Line : 4415 SONOMA HWY STE B
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409-4165
Country : US
Telephone Number : 707-327-0909
Fax Number :
Provider Business Practice Location Address
First Line : 4415 SONOMA HWY STE B
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409-4165
Country : US
Telephone Number : 707-327-0909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2026
Last Update Date : 03/27/2026

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Directions to “ EMILY NICOLE JIREL ” Practice Location

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