Provider Demographics
NPI:1891262507
Name:WUNDERLICH, JACQUELINE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11431 AMHERST AVE #1764
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4383
Mailing Address - Country:US
Mailing Address - Phone:301-818-2431
Mailing Address - Fax:
Practice Address - Street 1:10823 AMHERST AVE APT A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4383
Practice Address - Country:US
Practice Address - Phone:734-890-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA922103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst