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NPI Code Detail

MEDICARE: JENNA KINCAID OMICK BCBA

MEDICARE: JENNA KINCAID OMICK 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
1106S00000XBehavior TechnicianCA
2103K00000XBehavior Analyst1-21-57043CA

General Provider Information

NPI Number : 1528559150
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA KINCAID OMICK BCBA
Provider Business Mailing Address
First Line : 3650 MT DIABLO BLVD STE 107
Second Line :
City : LAFAYETTE
State : CA
Zip : 94549-3768
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3650 MT DIABLO BLVD STE 107
Second Line :
City : LAFAYETTE
State : CA
Zip : 94549-3768
Country : US
Telephone Number : 510-679-3545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2018
Last Update Date : 01/11/2022

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Directions to “ JENNA KINCAID OMICK BCBA” Practice Location

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