Individual
FAY A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9433 N 70TH DR, PEORIA, AZ 85345-8874
(623) 847-1660
Mailing address
9433 N 70TH DR, PEORIA, AZ 85345-8874
(623) 847-1660
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/12/2023
Last updated
12/12/2023
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