Jenna L Wallack, M.S, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

11832632 Issued in MA

Practice address

132 Robbs Hill Rd
Lunenburg, MA 01462-2167

Phone

(978) 846-3318

NPI assigned

Jun 11, 2019

Last updated

Jun 15, 2023By the provider in NPPES

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1518526730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 THOMAS AVE",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018324468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 ROBBS HILL RD",
            "city": "LUNENBURG",
            "state": "MA",
            "postal_code": "014622167",
            "telephone_number": "978-846-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACK",
        "first_name": "JENNA",
        "middle_name": "L",
        "name_prefix": "Miss",
        "credential": "M.S, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MA",
            "license": "11832632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Lunenburg, MA
• Providers in Lunenburg, MA by specialty
• Behavior Analyst in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.