Individual
JESSICA DELLENBAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1704 WESTLAND RD, CHEYENNE, WY 82001-3322
(605) 271-2690
Mailing address
1105 W RUSSELL ST, SIOUX FALLS, SD 57104-1322
(052) 713-9566
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
111074-852
WY
106S00000X
Behavior Technician
Primary
RBT-21-175774
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111074-852
DIVERS LICENSE
WY
Enumeration date
10/13/2020
Last updated
08/10/2021
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