Individual
LATAYVIA SHERIS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35-34 21STREETAPT#1H, ASTORIA, NY 11106
(646) 240-0903
Mailing address
35-34 21STREETAPT#1H, ASTORIA, NY 11106
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/15/2017
Last updated
03/15/2017
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