Individual
CHRISTELLE TRACY JOURDAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 SAMMETT ST, MALDEN, MA 02148-5804
(781) 502-1876
Mailing address
124 SAMMETT ST, MALDEN, MA 02148-5804
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100020772487
—
MA
Enumeration date
07/21/2019
Last updated
07/21/2019
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