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NPI Code Detail

MEDICARE: JAKAILA BOATENG

MEDICARE: JAKAILA BOATENG
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 TechnicianBACB938370MD

General Provider Information

NPI Number : 1912654997
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKAILA BOATENG
Provider Business Mailing Address
First Line : 7120 SAMUEL MORSE DR STE 150
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3420
Country : US
Telephone Number : 888-344-5977
Fax Number :
Provider Business Practice Location Address
First Line : 7120 SAMUEL MORSE DR STE 150
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3420
Country : US
Telephone Number : 888-344-5977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2022
Last Update Date : 12/21/2025

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Directions to “ JAKAILA BOATENG ” Practice Location

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