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NPI Code Detail

MEDICARE: MRS. ELENA MICHELLE ZAKLIS BCBA, LBA

MEDICARE: MRS. ELENA MICHELLE ZAKLIS BCBA, LBA
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
1103K00000XBehavior Analyst0133001102VA

General Provider Information

NPI Number : 1063981538
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELENA MICHELLE ZAKLIS BCBA, LBA
Provider Business Mailing Address
First Line : 11150 SUNSET HILLS RD STE 150
Second Line :
City : RESTON
State : VA
Zip : 20190-5325
Country : US
Telephone Number : 703-471-5571
Fax Number : 703-471-5571
Provider Business Practice Location Address
First Line : 11150 SUNSET HILLS RD STE 150
Second Line :
City : RESTON
State : VA
Zip : 20190-5325
Country : US
Telephone Number : 703-471-5571
Fax Number : 703-471-5571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2018
Last Update Date : 11/14/2018

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