Individual
JACQUELINE SUE TANAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
5912 MAPLETON DR, COLORADO SPRINGS, CO 80918-5679
(719) 233-5680
Mailing address
5912 MAPLETON DR, COLORADO SPRINGS, CO 80918-5679
(719) 233-5680
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
Primary
0-07-2355
CO
Other
Enumeration date
09/12/2008
Last updated
06/14/2021
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