Provider Demographics
NPI:1194612069
Name:SENCKOWSKI, JACKSEN
Entity type:Individual
Prefix:
First Name:JACKSEN
Middle Name:
Last Name:SENCKOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAIN ST STE 149
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-2438
Mailing Address - Country:US
Mailing Address - Phone:774-757-7352
Mailing Address - Fax:
Practice Address - Street 1:500 MAIN ST STE 149
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-2438
Practice Address - Country:US
Practice Address - Phone:774-757-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician