Active NPI
Jaqueline Chagollan
- Behavior Technician
- Chandler, AZ
National Provider Identifier
1043890908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-21-151339
- Practice address
- 3215 W Ray Rd
Chandler, AZ 85226-2425 - Phone
- (480) 701-3607
- Fax
- (480) 546-4198
- NPI assigned
- Apr 13, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-21-151339 | AZ | Primary |
Addresses
Primary practice location
3215 W Ray Rd
Chandler, AZ 85226-2425
Mailing address
3215 W Ray Rd
Chandler, AZ 85226-2425
Phone (480) 701-3607
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-21-151339 | AZ | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Sprig Pediatrics, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Phoenix, AZ
- NPI 1629711288
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618272000000",
"number": "1043890908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3215 W RAY RD",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852262425",
"telephone_number": "480-701-3607",
"fax_number": "480-546-4198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3215 W RAY RD",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852262425",
"telephone_number": "480-701-3607",
"fax_number": "480-546-4198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAGOLLAN",
"first_name": "JAQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-13",
"last_updated": "2021-04-13",
"certification_date": "2021-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AZ",
"license": "RBT-21-151339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.