Individual
LONNIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8901 S. SANTE FE AVE, OKLAHOMA CITY, OK 73139
(405) 605-5757
Mailing address
915 SW 97TH ST, OKLAHOMA CITY, OK 73139-2801
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
OK
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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