Individual
DESTINY SHARAD JACKSON-HALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1024 W OWENS AVE, LAS VEGAS, NV 89106-2520
(702) 877-9850
Mailing address
1024 W OWENS AVE, LAS VEGAS, NV 89106-2520
(702) 877-9850
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
08/15/2018
Last updated
08/15/2018
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