Provider Demographics
NPI:1013358662
Name:BOSLEY, JACLYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:JACLYNN
Middle Name:
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 RICHMOND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-6411
Mailing Address - Country:US
Mailing Address - Phone:216-217-4562
Mailing Address - Fax:
Practice Address - Street 1:4670 RICHMOND RD STE 200
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-6411
Practice Address - Country:US
Practice Address - Phone:216-217-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-11-8047103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst