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Individual

HOLLY JEAN JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.ED, BCBA

Contact information

Practice address
19800 VILLAGE OFFICE CT, BEND, OR 97702-1872
(541) 480-2570
Mailing address
PO BOX 1432, BEND, OR 97709-1432
(541) 480-2570

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1-23-66904
BEHAVIOR ANALYST CERTIFICATION BOARD
OR
Enumeration date
06/12/2018
Last updated
08/08/2023
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