Individual
LYDIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
635 S MAIN ST, LEITCHFIELD, KY 42754-1011
(270) 287-0656
Mailing address
635 S MAIN ST, LEITCHFIELD, KY 42754-1011
(270) 287-0656
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
24-363679
KY
Other
Enumeration date
03/07/2025
Last updated
03/07/2025
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