Individual
JACK RYAN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4770 BASELINE RD STE 200, BOULDER, CO 80303-2668
(970) 982-3476
(855) 568-2494
Mailing address
4770 BASELINE RD STE 200, BOULDER, CO 80303-2668
(970) 982-3476
(855) 568-2494
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/25/2022
Last updated
03/25/2022
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