Individual
JACK BWEWUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
509 QUINCE ORCHARD RD STE 205, GAITHERSBURG, MD 20878-1435
(855) 832-6727
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
(772) 349-6317
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
106E00000X
MD
Other
Enumeration date
07/23/2026
Last updated
07/23/2026
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