Individual
MARY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4559 BENES AVE, GLEN CARBON, IL 62034-1541
(217) 525-8332
Mailing address
4559 BENES AVE, GLEN CARBON, IL 62034-1541
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-57035
IL
106E00000X
Assistant Behavior Analyst
—
—
Other
Enumeration date
08/13/2020
Last updated
07/03/2023
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