Provider Demographics
NPI:1356131510
Name:NAVARRO, JACQUELYN (RBT)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50025
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-0025
Mailing Address - Country:US
Mailing Address - Phone:307-226-0479
Mailing Address - Fax:
Practice Address - Street 1:437 S SPRUCE ST STE C
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1759
Practice Address - Country:US
Practice Address - Phone:307-226-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYBACB1303394106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician