Individual
JACK WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
609 W 10TH ST, MEDFORD, OR 97501-3106
(541) 774-4810
Mailing address
609 W 10TH ST, MEDFORD, OR 97501-3106
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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