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Individual

DAN JACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MS

Contact information

Practice address
11600 SW 4TH ST, YUKON, OK 73099-6706
(405) 229-4348
Mailing address
11600 SW 4TH ST, YUKON, OK 73099-6706
(405) 229-4348

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary

Other

Enumeration date
10/11/2013
Last updated
10/11/2013
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