Individual
RAYMOND JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2502 CROSSROADS DR, ARDMORE, OK 73401-2503
(580) 226-4800
Mailing address
PO BOX 913, ARDMORE, OK 73402-0913
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
103K00000X
OK
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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