Individual
ALYSSA RAUDEBAUGH-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
247 SW PORT ST. LUCIE BLVD, PORT ST. LUCIE, FL 34984
Mailing address
300 INTERNATIONAL PARKWAY SUITE 200, LAKE MARY, FL 32746
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-62662
FL
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/14/2020
Last updated
12/08/2022
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