Provider Demographics
NPI:1124634167
Name:SAUCEDO, JACKLYN PRICELLA (ASW)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:PRICELLA
Last Name:SAUCEDO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 MONTEREY RD # C
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3897
Mailing Address - Country:US
Mailing Address - Phone:626-437-9789
Mailing Address - Fax:
Practice Address - Street 1:5000 BIRCH ST STE 3000
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2140
Practice Address - Country:US
Practice Address - Phone:877-421-1711
Practice Address - Fax:949-576-3913
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW95935101YM0800X, 101YM0800X
CA959351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical