Annalissa Marie Jakupcak, M.A. BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-17-28865 Issued in CO

Practice address

6160 Tutt Blvd Ste 120
Colorado Springs, CO 80923-3503

Phone

(719) 540-2101

NPI assigned

Jan 11, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Annalissa Marie McCluan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

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.

• Family Support Center of Colorado, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Colorado Springs, CO
  • NPI 1134733512
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1215445267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6160 TUTT BLVD STE 120",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809233503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 TUTT BLVD STE 120",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809233503",
            "telephone_number": "719-540-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKUPCAK",
        "first_name": "ANNALISSA",
        "middle_name": "MARIE",
        "credential": "M.A. BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-11",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CO",
            "license": "1-17-28865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNALISSA",
            "last_name": "MCCLUAN",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jagger F Lawrence DDS PC
• Hannah Elizabeth Jaggli
• Isabella Jahn
• Rupesh Jain, MD
• Alicia Jakomait
• Leandra Jakusz
• Jala
• Deborah Jalowiec, M.D.
• Zenith Arvind Jameria, MD
• James C Stewart PHD Professional Corporation

• Behavior Analyst in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Behavior Analyst in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.