Provider Demographics
NPI:1023409737
Name:MARSHALL, JESSIE (MAS, BCBA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MAS, BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2550 E GUADALUPE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5114
Mailing Address - Country:US
Mailing Address - Phone:480-847-8139
Mailing Address - Fax:
Practice Address - Street 1:2550 E GUADALUPE RD STE 107
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5114
Practice Address - Country:US
Practice Address - Phone:480-847-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AZBEH-000168103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst