Individual
ATHENA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
113 SALEM TPKE STE 200, NORWICH, CT 06360-6484
(888) 754-0398
Mailing address
113 SALEM TPKE STE 200, NORWICH, CT 06360-6484
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
128688030
CT
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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