Individual
JACK HENRY PADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1169 EASTERN PKWY STE G111, LOUISVILLE, KY 40217-1462
(502) 242-9091
Mailing address
996 ROYAL MARCO WAY, MARCO ISLAND, FL 34145-1829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/12/2025
Last updated
11/12/2025
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