Individual
SOMER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901-8685
(573) 686-1200
Mailing address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901-8685
(573) 686-1200
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
15674
MO
Other
Enumeration date
11/17/2022
Last updated
09/20/2024
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