Individual
JASMINE MALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 ABBOTT DR STE 2, BROOMALL, PA 19008-4323
(484) 995-6547
Mailing address
600 N JACKSON ST STE 203, MEDIA, PA 19063-2574
(484) 444-2285
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-52124
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-18-74281
BACB REGISTRATION NUMBER
—
Enumeration date
03/05/2019
Last updated
08/16/2021
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