Individual
CRYSTAL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3205 SHAWNEE TRL, ALAMOGORDO, NM 88310
(575) 491-5459
Mailing address
3205 SHAWNEE TRL, ALAMOGORDO, NM 88310-4020
(575) 491-5459
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NM
Other
Enumeration date
09/15/2015
Last updated
01/02/2020
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