Basic Information
| Provider Information | |||||||||
| NPI: | 1245778133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACHADO | ||||||||
| FirstName: | JESSICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21600 OXNARD ST | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913674976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183452345 | ||||||||
| FaxNumber: | 8187588015 | ||||||||
| Practice Location | |||||||||
| Address1: | 327 MAIN AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | DE PERE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541152202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203410123 | ||||||||
| FaxNumber: | 8187588015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2017 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | WI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.