Individual
LONNIE J PHILLIPS-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 E APACHE BLVD APT 3060, TEMPE, AZ 85281-1185
(775) 354-3675
Mailing address
1221 E APACHE BLVD APT 3060, TEMPE, AZ 85281-1185
(775) 354-3675
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000000
NONW
—
Enumeration date
01/23/2022
Last updated
01/23/2022
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