Individual
DIAMOND JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
343 FOUNTAINS PKWY # 201, FAIRVIEW HEIGHTS, IL 62208-2170
(618) 515-1441
Mailing address
343 FOUNTAINS PKWY # 201, FAIRVIEW HEIGHTS, IL 62208-2170
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1361836
MO
Other
Enumeration date
04/16/2026
Last updated
04/16/2026
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