Healthcare Provider Details

I. General information

NPI: 1417566969
Provider Name (Legal Business Name): FELICIA A BECKNER CWCM, CWLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 PARK ST
JACKSONVILLE FL
32205-7327
US

IV. Provider business mailing address

4624 PARK ST
JACKSONVILLE FL
32205-7327
US

V. Phone/Fax

Practice location:
  • Phone: 904-503-0131
  • Fax:
Mailing address:
  • Phone: 904-503-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: