Individual
LACEY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 LISA AVE, LATHROP, MO 64465-9641
(816) 398-3255
Mailing address
124 LISA AVE, LATHROP, MO 64465-9641
(816) 398-3255
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/12/2019
Last updated
06/12/2019
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