Provider Demographics
NPI:1376845693
Name:MILTON, JEANNA LORAY (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:LORAY
Last Name:MILTON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 BARTOW RD
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4309
Mailing Address - Country:US
Mailing Address - Phone:077-672-5527
Mailing Address - Fax:707-633-1755
Practice Address - Street 1:1622 BARTOW RD
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4309
Practice Address - Country:US
Practice Address - Phone:707-672-5527
Practice Address - Fax:707-633-1755
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-10-7508OtherBEHAVIOR ANALYSIT BOARD CERTIFICATION NUMBER