Individual
A'TAJA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 CHURCH ST, PHILADELPHIA, PA 19106-2201
(267) 807-0550
Mailing address
4120 N BROAD ST, PHILADELPHIA, PA 19140-3013
(267) 317-5970
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/05/2024
Last updated
02/05/2024
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