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General NPI Number Information
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NPI Number | 1801447735
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Entity Type | Individual
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Provider Name | JANE SUZANNE WHITE BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 1200 CONCORD AVE STE 100
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City | CONCORD
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State | CA
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Zip | 94520-4969
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Country | US
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Telephone | 877-910-6538
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Fax |
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Provider Business Mailing Address
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Address Line | 5530 ROMAN CT
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City | FERNDALE
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State | WA
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Zip | 98248-8581
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Country | US
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Telephone | 360-319-0317
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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 | 1-19-38497
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License Number State | WA
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