Individual
JESSICA BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
436 STATION AVE, SOUTH YARMOUTH, MA 02664-1208
(508) 694-0101
Mailing address
21600 OXNARD ST, WOODLAND HILLS, CA 91367-4976
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
S84257855
MA
Other
Enumeration date
02/06/2018
Last updated
02/06/2018
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