MEDICARE: JAQUELYN CONTRERAS M.A., 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
1	103K00000X	Behavior Analyst	BEH-001718	AZ

General Provider Information

NPI Number	:	1801413760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAQUELYN CONTRERAS M.A., BCBA, LBA

Provider Business Mailing Address
First Line	:	13625 S 48TH ST APT 1180
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5055
Country	:	US
Telephone Number	:	480-745-9389
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 E YEAGER DR STE 14
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-1578
Country	:	US
Telephone Number	:	480-741-1937
Fax Number	:

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	01/17/2025

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