MEDICARE: MRS. ALLISON JAYNE WOMACK M.A.

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

General Provider Information

NPI Number	:	1861725780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON JAYNE WOMACK M.A.

Provider Business Mailing Address
First Line	:	1914 7TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-7008
Country	:	US
Telephone Number	:	916-869-2932
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 3RD ST
Second Line	:	SUITE 108
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-1100
Country	:	US
Telephone Number	:	916-443-2479
Fax Number	:

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	10/24/2016

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