Individual
JAZMINE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
634 N MAIN ST STE 4, O FALLON, IL 62269-3746
(618) 726-5870
Mailing address
634 N MAIN ST STE 4, O FALLON, IL 62269-3746
(618) 726-5870
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
42542204906N
IL
Other
Enumeration date
03/20/2026
Last updated
03/20/2026
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