Healthcare Provider Details

I. General information

NPI: 1275322109
Provider Name (Legal Business Name): JESSICA UGOLIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 E COLORADO BLVD STE 200
PASADENA CA
91105-1955
US

IV. Provider business mailing address

136 WILLIAM ST
SPRINGFIELD MA
01105-2324
US

V. Phone/Fax

Practice location:
  • Phone: 844-669-7827
  • Fax:
Mailing address:
  • Phone: 413-331-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: