MEDICARE: ALEESA BLACKBURN

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	106E00000X	Assistant Behavior Analyst	Y6628577	CA

General Provider Information

NPI Number	:	1699601682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEESA BLACKBURN

Provider Business Mailing Address
First Line	:	44028 4TH ST E
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-3613
Country	:	US
Telephone Number	:	661-877-2878
Fax Number	:

Provider Business Practice Location Address
First Line	:	44028 4TH ST E
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-3613
Country	:	US
Telephone Number	:	661-877-2878
Fax Number	:

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

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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Directions to “ ALEESA BLACKBURN ” Practice Location

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