Individual
TANYA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ABA TECHNICIAN
Contact information
Practice address
1220 PEARL ST, BENTON HARBOR, MI 49022-5539
(269) 252-1540
Mailing address
3916 STONEGATE, CENTRIA HEALTHCARE, SAINT JOSEPH, MI 49022
(269) 252-1540
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
05/25/2016
Last updated
05/25/2016
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