Individual
AVERY JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
731 BIELENBERG DR STE 102-104, WOODBURY, MN 55125-1700
(612) 439-4653
Mailing address
1980 7TH ST W APT 101, SAINT PAUL, MN 55116-3202
(651) 353-8559
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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