Individual
JACKYMORE K IWUALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 OAK ST STE G20, NEWTON, MA 02464-1492
(617) 658-5611
Mailing address
23 MCCORMICK TER, STOUGHTON, MA 02072-2443
(617) 792-1238
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB502983
MA
Other
Enumeration date
11/15/2018
Last updated
07/22/2021
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