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Individual
CASEY L JACK
Active
Individual
CASEY L JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133002731
VA
106S00000X
Behavior Technician
RBT-20-123485
VA
Other
Enumeration date
01/21/2021
Last updated
10/02/2022
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