Basic Information
| Provider Information | |||||||||
| NPI: | 1124634167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAUCEDO | ||||||||
| FirstName: | JACKLYN | ||||||||
| MiddleName: | PRICELLA | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1407 MONTEREY RD # C | ||||||||
| Address2: | |||||||||
| City: | SOUTH PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910303897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264379789 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2750 E WASHINGTON BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911071449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262968900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2020 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW95935 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.