Provider Demographics
NPI:1336741206
Name:ACKERMAN, LAURA (BCBA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 UNION AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-3156
Mailing Address - Country:US
Mailing Address - Phone:650-722-1564
Mailing Address - Fax:
Practice Address - Street 1:131 UNION AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3156
Practice Address - Country:US
Practice Address - Phone:650-722-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-20723103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst