Provider Demographics
NPI:1376282137
Name:SSEBAKIJJE, PATRICIA GRACE (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GRACE
Last Name:SSEBAKIJJE
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 SPARTAN LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-9071
Mailing Address - Country:US
Mailing Address - Phone:909-510-3442
Mailing Address - Fax:
Practice Address - Street 1:12007 SPARTAN LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-9071
Practice Address - Country:US
Practice Address - Phone:909-510-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty