Provider Demographics
NPI:1376805002
Name:STAWINSKI, JACQUELYN (BCBA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:STAWINSKI
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 1:14114 POLK ST
Mailing Address - Street 2:200
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-2918
Mailing Address - Country:US
Mailing Address - Phone:818-991-7722
Mailing Address - Fax:
Practice Address - Street 1:14114 POLK ST
Practice Address - Street 2:200
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-2918
Practice Address - Country:US
Practice Address - Phone:818-991-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7317103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst