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NPI Code Detail

MEDICARE: JACQUELINE JOANNE MADELINE BA, RBT

MEDICARE: JACQUELINE JOANNE MADELINE BA, RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-19-100316AZ
2103K00000XBehavior Analyst1-25-81243IN

General Provider Information

NPI Number : 1306453790
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE JOANNE MADELINE BA, RBT
Provider Business Mailing Address
First Line : 27777 INKSTER RD STE 100
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-5312
Country : US
Telephone Number : 248-436-4400
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 7770 E WRIGHTSTOWN RD
Second Line :
City : TUCSON
State : AZ
Zip : 85715-4330
Country : US
Telephone Number : 888-975-4557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2020
Last Update Date : 06/07/2025

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