Provider Demographics
NPI:1336858349
Name:JANNICE, ROSALIND
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:JANNICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 E G ST APT 132
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5432
Mailing Address - Country:US
Mailing Address - Phone:909-996-1019
Mailing Address - Fax:
Practice Address - Street 1:1733 E G ST APT 132
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5432
Practice Address - Country:US
Practice Address - Phone:909-996-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst