Individual
JACLYN MICHELE DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, LBS, BCBA
Contact information
Practice address
136 TRADEWIND RD, NEW CASTLE, PA 16102-2705
(855) 400-3455
Mailing address
136 TRADEWIND RD, NEW CASTLE, PA 16102-2705
(855) 400-3455
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-46986
PA
106S00000X
Behavior Technician
RBT-17-44763
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106S00000X
PRIVATE INSURANCE
—
Enumeration date
08/12/2019
Last updated
01/15/2021
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