Healthcare Provider Details

I. General information

NPI: 1023945235
Provider Name (Legal Business Name): JACQLYN JAMESON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13980 BLOSSOM HILL RD STE B
LOS GATOS CA
95032-5121
US

IV. Provider business mailing address

15466 LOS GATOS BLVD # 109-45
LOS GATOS CA
95032-2542
US

V. Phone/Fax

Practice location:
  • Phone: 161-979-5992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberF7203246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: