Provider Demographics
NPI:1891206496
Name:BAILEY, JACQUELINE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:BEAULIEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2863 MCLELLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4617
Mailing Address - Country:US
Mailing Address - Phone:516-984-8167
Mailing Address - Fax:
Practice Address - Street 1:66-437 KAMEHAMEHA HWY UNIT 95
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-3005
Practice Address - Country:US
Practice Address - Phone:808-518-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-207103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst