Individual
JAKIA DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
634 N MAIN ST STE 4, O FALLON, IL 62269-3746
(618) 726-0701
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
D242-4329-9873
IL
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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