Individual
JACK PETER TIEMESSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHA
Contact information
Practice address
401 8TH ST APT 206, JUNEAU, AK 99801-1002
(907) 903-0464
Mailing address
401 8TH ST APT 206, JUNEAU, AK 99801-1002
(907) 903-0464
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/17/2021
Last updated
01/17/2021
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