Provider Demographics
NPI:1568632107
Name:POKRZYWINSKI, JOHN J (BCBA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:POKRZYWINSKI
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:J
Other - Last Name:POKRZYWINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:711 SW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8273
Mailing Address - Country:US
Mailing Address - Phone:515-783-4322
Mailing Address - Fax:
Practice Address - Street 1:711 SW 46TH ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8273
Practice Address - Country:US
Practice Address - Phone:515-783-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-04-1522103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1568632107Medicaid