Individual
DOMINIQUE RENA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
2560 1ST AVE S APT 108, ALTOONA, IA 50009-1756
(402) 317-9235
Mailing address
1649 61ST STREET, ST 301, 3RD FL,, BROOKLYN, NY 11204
(402) 252-8181
(402) 252-8787
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/20/2025
Last updated
02/20/2025
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