Basic Information
| Provider Information | |||||||||
| NPI: | 1972969517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEGLEY | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 934 YOSEMITE LN | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957627324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099233583 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1337 HOWE AVE | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958253361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165645010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2016 | ||||||||
| LastUpdateDate: | 01/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.