Provider Demographics
NPI:1922560697
Name:KAMMER, JACQUELINE SUSAN (MS, NCSP, BCBA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUSAN
Last Name:KAMMER
Suffix:
Gender:F
Credentials:MS, NCSP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 HANNUM AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6525
Mailing Address - Country:US
Mailing Address - Phone:310-839-9088
Mailing Address - Fax:
Practice Address - Street 1:4221 WILSHIRE BLVD STE 300A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3537
Practice Address - Country:US
Practice Address - Phone:888-428-3223
Practice Address - Fax:323-866-1881
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-34470103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst