Individual
LATOYA NICHOLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1717 W 33RD ST, EDMOND, OK 73013-3819
(405) 216-5608
(405) 216-5272
Mailing address
1500 MEYERS PL, OKLAHOMA CITY, OK 73111-6014
(405) 921-3977
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200123000A
—
OK
Enumeration date
11/24/2010
Last updated
11/24/2010
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