MEDICARE: JESSICA SHANKS PLBA

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	2026020706	MO

General Provider Information

NPI Number	:	1891620472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SHANKS PLBA

Provider Business Mailing Address
First Line	:	1721 W ELFINDALE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-1295
Country	:	US
Telephone Number	:	417-605-7100
Fax Number	:	417-708-0889

Provider Business Practice Location Address
First Line	:	1721 W ELFINDALE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-1295
Country	:	US
Telephone Number	:	417-605-7100
Fax Number	:	417-708-0889

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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