Individual
JAYDEN VICTORIA BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
716 E MAIN PL, JENKS, OK 74037
(479) 318-2300
Mailing address
17507 E 44TH ST, TULSA, OK 74134-6021
(682) 336-5438
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Enumeration date
04/15/2025
Last updated
04/15/2025
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