MEDICARE: JESSICA LEEANN RIMES MSPECED BCBA

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	103K00000X	Behavior Analyst	1-17-27052	IN
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14107084	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1-17-27052	OTHER	CA	BACB CERTIFICATION

General Provider Information

NPI Number	:	1568915692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEEANN RIMES MSPECED BCBA

Provider Business Mailing Address
First Line	:	3201 STELLHORN RD STE I148
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4697
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	317-520-8200

Provider Business Practice Location Address
First Line	:	3201 STELLHORN RD STE I148
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4697
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	12/14/2021

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