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General NPI Number Information
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NPI Number | 1326571514
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Entity Type | Individual
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Provider Name | JACQUELYN LANGSTON M.S., BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 1433 N WATER ST STE 400
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City | MILWAUKEE
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State | WI
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Zip | 53202-2603
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Country | US
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Telephone | 947-622-2008
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Fax |
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Provider Business Mailing Address
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Address Line | 5570 SPANISH MOSS CV
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City | BRADENTON
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State | FL
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Zip | 34203-2114
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Country | US
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Telephone | 586-913-5024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-25321
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License Number State | FL
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