Individual
JESSICA MARIE CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 SANTA CLAUSE, NORTH POLE, AK 99705
(469) 338-2901
Mailing address
203 SANTA CLAUSE, NORTH POLE, AK 99705
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-18-69145
—
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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