Individual
JALESSA MABRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7777 BONHOMME AVE STE 1800, CLAYTON, MO 63105-1931
(163) 620-2069
Mailing address
18726 S WESTERN AVE, GARDENA, CA 90248-3813
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MO
Other
Enumeration date
02/04/2022
Last updated
02/04/2022
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