Individual
JENNIFER JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
729 N GREENBRIER AVE, COVINGTON, VA 24426-1319
(540) 691-9655
Mailing address
729 N GREENBRIER AVE, COVINGTON, VA 24426-1319
(540) 691-9655
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-6769-52485
VA
Other
Enumeration date
02/09/2017
Last updated
02/09/2017
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