Healthcare Provider Details

I. General information

NPI: 1245836410
Provider Name (Legal Business Name): JENNIFER HELENA ONUSCHAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER SAPKOSKY

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 HIGHWAY 314
FAYETTEVILLE GA
30214-7813
US

IV. Provider business mailing address

3800 TROTTERS RUN
DOUGLASVILLE GA
30135-7602
US

V. Phone/Fax

Practice location:
  • Phone: 770-249-5322
  • Fax:
Mailing address:
  • Phone: 484-934-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79796
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: