Provider Demographics
NPI:1316101603
Name:YAKOS, JENNIFER (BA, MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:YAKOS
Suffix:
Gender:F
Credentials:BA, MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 49TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1902
Mailing Address - Country:US
Mailing Address - Phone:619-248-3555
Mailing Address - Fax:
Practice Address - Street 1:7297 RONSON RD STE H
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1428
Practice Address - Country:US
Practice Address - Phone:858-278-6603
Practice Address - Fax:858-278-6605
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1938171M00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-04-1938OtherBOARD CERTIFIED BEHAVIOR ANALYST