MEDICARE: JACQUELYN LANGSTON M.S., BCBA

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
1	103K00000X	Behavior Analyst	1-17-25321	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326571514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN LANGSTON M.S., BCBA

Provider Business Mailing Address
First Line	:	5570 SPANISH MOSS CV
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-2114
Country	:	US
Telephone Number	:	586-913-5024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 N WATER ST STE 400
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2603
Country	:	US
Telephone Number	:	947-622-2008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/29/2024

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