Individual
GRACE ELISABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 E MOUNTAIN VIEW AVE STE 4, ELLENSBURG, WA 98926-3795
(509) 852-4020
Mailing address
41 FAIRPOINT DR STE G, GULF BREEZE, FL 32561-4380
(850) 733-9336
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/30/2023
Last updated
07/24/2024
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