Individual
ALYSSA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
164 RAE DR, PALM COAST, FL 32164-6895
(386) 986-9724
Mailing address
23 RYBAR LN, PALM COAST, FL 32164-6445
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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