Individual
KENDRA H JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 INDEPENDENCE BLVD BLDG 6, ZACHARY, LA 70791-7390
(225) 286-1547
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922566934
—
LA
Enumeration date
01/26/2022
Last updated
02/16/2022
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