Individual
MRS. KRISTA LEE IRVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 LAURENCE AVE STE E, JACKSON, MI 49202-2980
(517) 750-4777
Mailing address
2021 S SANDSTONE RD, JACKSON, MI 49201-9371
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401001428
MI
Other
Enumeration date
02/28/2019
Last updated
06/20/2024
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