Individual
JESSICA MICHELLE GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 PENNSYLVANIA ST NE UNIT I9, ALBUQUERQUE, NM 87110-5500
(505) 449-8782
Mailing address
1601 PENNSYLVANIA ST NE UNIT I9, ALBUQUERQUE, NM 87110-5500
(505) 449-8782
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/25/2022
Last updated
04/25/2022
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