Staci Jackson, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-07-3619

Practice address

7226 Sepulveda Blvd
Van Nuys, CA 91405-2003

Phone

(818) 235-1414

Fax

(818) 235-1418

NPI assigned

Nov 30, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• A Change in Trajectory, Inc.

  • Behavior Analyst
  • Van Nuys, CA
  • NPI 1750646667
  NPD (past)

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1487956249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7226 SEPULVEDA BLVD",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914052003",
            "telephone_number": "818-235-1414",
            "fax_number": "818-235-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7226 SEPULVEDA BLVD",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914052003",
            "telephone_number": "818-235-1414",
            "fax_number": "818-235-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STACI",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-30",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-07-3619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Ashley Jackman, LCSW
• Bryanna Jackson
• Chloe Jackson
• Jaylynn Jackson
• Kammie Jackson
• Patricia Jacobo, MS
• Irving Lionel Jacobs, D.C.
• Russell Jacobs Jr.
• Marwa Jad, ASW
• Jade T. Ong DDS. Inc.

• Behavior Analyst in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.

Verify at the official NPI Registry.