Provider Demographics
NPI:1962767640
Name:SHANDY, JACLYN ANN (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:ANN
Last Name:SHANDY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3920 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2839
Mailing Address - Country:US
Mailing Address - Phone:916-879-0021
Mailing Address - Fax:916-448-6050
Practice Address - Street 1:425 UNIVERSITY AVE STE 201
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6509
Practice Address - Country:US
Practice Address - Phone:916-448-2050
Practice Address - Fax:916-448-6050
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-07-3409 BCBA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst