Individual
JERRELL SHANAE WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4535 W RUSSELL RD STE 15, LAS VEGAS, NV 89118-2258
(702) 368-2380
Mailing address
312 BURGOS AVE, NORTH LAS VEGAS, NV 89030-4718
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/16/2021
Last updated
04/16/2021
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