Individual
MRS. BETHANY DAWN JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
382 BON HAVEN RD, MAYSVILLE, KY 41056-9702
(606) 584-0518
Mailing address
382 BON HAVEN RD, MAYSVILLE, KY 41056
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
000083087
KY
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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