Individual
MISS DASARAY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20860 N TATUM BLVD STE 300, PHOENIX, AZ 85050-4283
(866) 342-8847
Mailing address
3201 W DESERT COVE AVE, PHOENIX, AZ 85029-4211
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-16-13608
AZ
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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