Individual
JACK O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3231 WILLAMETTE DR NE STE A, LACEY, WA 98516-1378
(360) 878-6434
Mailing address
3231 WILLAMETTE DR NE STE A, LACEY, WA 98516-1378
(360) 878-6434
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
61676193
WA
Other
Enumeration date
04/09/2025
Last updated
04/09/2025
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