Individual
JILLIAN SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10450 102ND ST, OZONE PARK, NY 11417-2237
(646) 377-7721
Mailing address
9011 160TH ST APT B902, JAMAICA, NY 11432-6159
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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