MEDICARE: JESSICA LAUREN TAHERI

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	:	1730895715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LAUREN TAHERI

Provider Business Mailing Address
First Line	:	990 KLAMATH LN STE 9
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-8978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2187 GOLDEN GATE DR
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-9062
Country	:	US
Telephone Number	:	530-632-3162
Fax Number	:

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

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	01/24/2023

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Directions to “ JESSICA LAUREN TAHERI ” Practice Location

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