Provider Demographics
NPI:1154666907
Name:CLANTON, JILLIAN E (BCBA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:CLANTON
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 1:350 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6525
Mailing Address - Country:US
Mailing Address - Phone:925-577-0258
Mailing Address - Fax:
Practice Address - Street 1:350 ROSE AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6525
Practice Address - Country:US
Practice Address - Phone:925-577-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst