Provider Demographics
NPI:1730803040
Name:JACKOWSKI, TIFFANY RENE (BCBA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENE
Last Name:JACKOWSKI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2796 STONEBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1568
Mailing Address - Country:US
Mailing Address - Phone:469-473-3050
Mailing Address - Fax:
Practice Address - Street 1:2796 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1568
Practice Address - Country:US
Practice Address - Phone:469-473-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst