MEDICARE: JACLYNN ASHLEY CZECH M.ED., BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1063955292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYNN ASHLEY CZECH M.ED., BCBA

Provider Business Mailing Address
First Line	:	5232 KINGS CIR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-1605
Country	:	US
Telephone Number	:	321-432-3277
Fax Number	:

Provider Business Practice Location Address
First Line	:	5637 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3061
Country	:	US
Telephone Number	:	612-767-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2016
Last Update Date	:	02/11/2026

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