Individual
JELISA PHILLIPPI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
112 UNIVERSITY DR N STE 300, FARGO, ND 58102-4661
(701) 388-9345
Mailing address
112 UNIVERSITY DR N STE 300, FARGO, ND 58102-4661
(701) 388-9345
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-28640
—
174400000X
Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-17-28640
BEHAVIOR ANALYST CERTIFICATION BOARD
—
Enumeration date
05/26/2017
Last updated
04/21/2020
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