Individual
JESSICA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24024 EVERGREEN RD APT 108A, SOUTHFIELD, MI 48075-5517
(313) 318-8618
Mailing address
31188 MISTY PINES DR, FARMINGTON HILLS, MI 48336-1256
(248) 885-7613
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
01/20/2016
Last updated
02/23/2021
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