Individual
MR. TOMMY DALE JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
540 W INTERNATIONAL AIRPORT RD, ANCHORAGE, AK 99518-1105
(907) 561-5335
Mailing address
1711 LORE RD APT 302, ANCHORAGE, AK 99507-2969
(907) 570-4478
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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