Individual
KELLIJO JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2827 PARKLANE DR, BOSQUE FARMS, NM 87068-8901
(505) 401-1969
Mailing address
2827 PARKLANE DR, BOSQUE FARMS, NM 87068-8901
(505) 401-1969
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/02/2024
Last updated
12/02/2024
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