Individual
MIKAYLA SHYANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17 W RED BANK AVE, WOODBURY, NJ 08096-1630
(718) 215-5311
(718) 865-5165
Mailing address
PO BOX 360595, PITTSBURGH PA 15251, PO BOX 360595, PITTSBURGH, PA 15251-0001
(718) 215-5311
(718) 865-5165
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/11/2025
Last updated
12/11/2025
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