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NPI Code Detail

MEDICARE: JENNA NICOLE VALK M.A., BCBA

MEDICARE: JENNA NICOLE VALK M.A., 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
1103K00000XBehavior Analyst1-12-11913CA

General Provider Information

NPI Number : 1750672994
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA NICOLE VALK M.A., BCBA
Provider Business Mailing Address
First Line : 7109 DANNY DR
Second Line :
City : STOCKTON
State : CA
Zip : 95210-5320
Country : US
Telephone Number : 209-957-7777
Fax Number :
Provider Business Practice Location Address
First Line : 7109 DANNY DR
Second Line :
City : STOCKTON
State : CA
Zip : 95210-5320
Country : US
Telephone Number : 209-957-7777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2011
Last Update Date : 08/13/2012

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