Provider Demographics
NPI:1245480573
Name:DAGNAN, JAYLENE KAY (MS, BCBA)
Entity type:Individual
Prefix:MISS
First Name:JAYLENE
Middle Name:KAY
Last Name:DAGNAN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13332 QUEEN PALM RUN
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-5294
Mailing Address - Country:US
Mailing Address - Phone:239-822-6886
Mailing Address - Fax:239-656-6577
Practice Address - Street 1:1937 GRACE AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7119
Practice Address - Country:US
Practice Address - Phone:239-822-6886
Practice Address - Fax:239-656-6577
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities