Healthcare Provider Details

I. General information

NPI: 1568938066
Provider Name (Legal Business Name): ADELE JACKSEEN PIERRE M.S., BCBA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADELE JACKSEEN POLIARD

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SHATTO PL STE 100
LOS ANGELES CA
90020-1747
US

IV. Provider business mailing address

501 SHATTO PL STE 100
LOS ANGELES CA
90020-1747
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3223
  • Fax: 323-866-1881
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2415
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31560
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: