Individual
SHANIQUA MONAE JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA
Contact information
Practice address
127 WILLIAMSBURG ST BLDG E, LAKE CHARLES, LA 70605-5719
(337) 376-0136
Mailing address
PO BOX 12703, LAKE CHARLES, LA 70612-2703
(337) 376-0136
(337) 376-5244
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L-773
LA
Other
Enumeration date
08/10/2023
Last updated
08/28/2023
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