Individual
FREDERICKA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9550 UNITED PLAZA BLVD, STE 702 -N, BATON ROUGE, LA 70809-0200
(954) 603-7885
Mailing address
2688 OLD TOWNE DR, ZACHARY, LA 70791-2777
(225) 993-5993
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
10
LA
Other
Enumeration date
10/09/2015
Last updated
10/09/2015
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