Individual
JACKLYN CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2021 MONROE ST, DEARBORN, MI 48124-2926
(517) 245-4777
(517) 698-8223
Mailing address
PO BOX 12279, LANSING, MI 48901-2279
(517) 245-4777
(517) 698-8223
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
04/17/2017
Last updated
08/24/2022
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