Individual
EMILEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
585 E LAKEVIEW PKWY BLDG 6, PROVO, UT 84606-7312
(801) 935-4171
Mailing address
16255 VENTURA BLVD STE 830, ENCINO, CA 91436-2317
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/03/2025
Last updated
03/03/2025
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