Individual
KAMERON NICHOLAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
901 PECAN ST APT 52, HAMMOND, LA 70401-2380
(985) 215-2084
Mailing address
901 PECAN ST APT 52, HAMMOND, LA 70401-2380
(985) 215-2084
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
010944287
LA
Other
Enumeration date
08/24/2019
Last updated
08/24/2019
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