Individual
BIANCA TANGELA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6757 S MERRILL AVE APT 2, CHICAGO, IL 60649-1264
(773) 822-8677
Mailing address
6757 S MERRILL AVE APT 2, CHICAGO, IL 60649-1264
(773) 822-8677
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
IL
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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