Provider Demographics
NPI:1033702048
Name:JARVIS, JACQUELINE AMALIA (RBT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:AMALIA
Last Name:JARVIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14519 BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2682
Mailing Address - Country:US
Mailing Address - Phone:913-526-1701
Mailing Address - Fax:
Practice Address - Street 1:7050 W 107TH ST STE 110
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1829
Practice Address - Country:US
Practice Address - Phone:913-802-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSRBT-20-122258106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician