HOLLY JEAN JACKSON (NPI# 1548753700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548753700 |
| Entity Type | Individual |
| Full Name | HOLLY JEAN JACKSON |
| Practice Address |
19800 Village Office Ct Bend OR 97702-1872 |
| Mailing Address |
Po Box 1432 Bend OR 97709-1432 |
| Practice Telephone | 5414802570 |
| Mailing Telephone | 5414802570 |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-06-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | ABA-IN-10192155 | OR | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689275802 | Holly Marie Jackson | Technician | 448 W Cooper St, Tipton, MO 65081-8217 | 2020-11-04 |
| 1689156721 | Holly Alegro Jackson | Non-emergency Medical Transport (VAN) | 10550 Murat Dr, Saint Louis, MO 63136-4524 | 2018-09-05 |
| 1417351453 | Holly Jean Jackson | Licensed Practical Nurse | 5a Lafayette Avenue, Canandaigua, NY 14424 | 2014-10-20 |
| 1013212711 | Holly Jackson | Social Worker | 511 W 86th Ter, Kansas City, MO 64114-2822 | 2011-01-11 |
| 1083882278 | Holly Jackson | Licensed Practical Nurse | 2040 Murray Holladay Rd Ste 205, Salt Lake City, UT 84117-5197 | 2008-02-11 |
| 1922596220 | Holly Suzanne Jackson | Counselor | 1100 Walnut St, Owensboro, KY 42301-2956 | 2018-04-23 |
| 1720575392 | Holly Jackson | Nurse Anesthetist, Certified Registered | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2018-04-18 |
| 1427576511 | Holly M Jackson | Nurse Practitioner | 905 Dixie St, Carrollton, GA 30117-4417 | 2017-09-08 |
| 1427597301 | Holly Jackson | Registered Nurse | 1109 Jones St, Kennett, MO 63857-3824 | 2017-02-13 |
| 1023551223 | Holly V Jackson | Advanced Practice Midwife | 1900 S Tuttle Ave, Sarasota, FL 34239-3114 | 2016-11-21 |
| Street Address |
19800 VILLAGE OFFICE CT |
| City | BEND |
| State | OR |
| Zip Code | 97702-1872 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558781864 | Eamon Campbell | Behavioral Analyst | 19800 Village Office Ct, 104, Bend, OR 97702-1872 | 2014-04-25 |
| 1619415700 | Sharon Balsamo | Counselor | 19800 Village Office Ct, Suite 105, Bend, OR 97702-1872 | 2017-02-08 |
| 1932658101 | Troy Forsyth | Behavioral Analyst | 19800 Village Office Ct, 104, Bend, OR 97702-1872 | 2016-09-28 |
| 1417300906 | Erin Mcavoy | Behavior Technician | 19800 Village Office Ct, Suite 104, Bend, OR 97702-1872 | 2016-07-20 |
| 1164875563 | Delaney Frye | Behavioral Analyst | 19800 Village Office Ct, Bend, OR 97702-1872 | 2016-07-20 |
| 1669830360 | Kristin M Randy | Behavior Technician | 19800 Village Office Ct, Suite #104, Bend, OR 97702-1872 | 2016-02-09 |
| 1083090153 | Taylor Grace Keenen | Behavioral Analyst | 19800 Village Office Ct, #104, Bend, OR 97702-1872 | 2015-07-30 |
| 1295123560 | Tamra Caldwell | Behavior Technician | 19800 Village Office Ct, 104, Bend, OR 97702-1872 | 2015-01-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629676259 | Amy Michelle Anderson | Counselor | 233 Sw Wilson Ave, Ste 201, Bend, OR 97702 | 2020-10-15 |
| 1386259463 | Jacob Rehder | Counselor | 19717 Mt Batchelor Dr, #226, Bend, OR 97702 | 2020-09-15 |
| 1497385215 | Capacity Performance Therapy | Physical Medicine & Rehabilitation | 61125 Lodgepole Dr., Bend, OR 97702 | 2020-01-21 |
| 1962041707 | Shift Bend Functional Medicine | Family Medicine | 151 Sw Shevlin Hicks Dr, Suite #1, Bend, OR 97702 | 2019-12-26 |
| 1609435049 | Praxis Medical Group Inc | Orthopaedic Surgery | 1140 Sw Simpson Avenue, Suite 100, Bend, OR 97702 | 2019-06-10 |
| 1013485754 | Elana Leah Pesah | Social Worker | 138 Maaglei Harim Levin, Jerusalem, ISRAEL 97702 | 2018-11-12 |
| 1104303239 | Kyleigh Mcvey | Massage Therapist | 999 Sw Disk Dr, Bend, OR 97702 | 2018-07-21 |
| 1477042869 | Siloe Castaneda Huerta | Counselor | 1340 Nw Wall, Bend, Or, Bend, OR 97702 | 2018-05-02 |
| 1164910808 | Rebecca M Joyce | Social Worker | 1011 Sw Emkay Dr. Suite 101, Bend, OR 97702 | 2018-04-27 |
| 1093217978 | Jennifer Bury | Acupuncturist | 296 Sw Columbia St Ste D1, Bend, OR 97702 | 2018-03-06 |
| Find all providers in zip 97702 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467077628 | Holly Brandt | Behavior Technician | 478 Ne Burnside Ave, Bend, OR 97701-5123 | 2020-06-13 |
| 1831730969 | Caroline Arechiga | Behavior Technician | 1550 Ne Williamson Blvd Ste 12097703, Bend, OR 97701-6091 | 2019-09-30 |
| 1942861422 | Marlon Galindo | Behavior Technician | 1550 Ne Williamson Blvd # 120, Bend, OR 97701-6071 | 2019-06-25 |
| 1366949562 | Haley Alexandra Davis | Behavior Technician | 300 Se Reed Market Rd # 205, Bend, OR 97702-2237 | 2018-04-12 |
| 1881191047 | Elizabeth Prieto | Behavior Technician | 19800 Village Office Ct # Cf104, Bend, OR 97702-1872 | 2018-04-12 |
| 1992211288 | Julie Haskett | Behavior Technician | 300 Se Reed Market Rd Ste 205, Bend, OR 97702-2237 | 2017-12-21 |
| 1023615879 | Gabrielle Johnson | Behavior Technician | 1550 Ne Williamson Blvd Ste 120, Bend, OR 97701-6091 | 2020-10-05 |
| 1821600651 | Emilee Dawson | Behavior Technician | 19800 Village Office Ct Ste 104, Bend, OR 97702-1813 | 2020-08-21 |
| 1245858851 | Bethany Leeann Imus | Behavior Technician | 1550 Ne Williamson Blvd Ste 120, Bend, OR 97701-6091 | 2020-07-09 |
| 1487271979 | Anthony Parker-hoang | Behavior Technician | 1550 Ne Williamson Blvd Ste 120, Bend, OR 97701-6091 | 2020-06-30 |
| Find all providers in BEND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.