Individual
SHAWANDA E JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
303 VETERANS BLVD, DENHAM SPRINGS, LA 70726-4723
(225) 250-9654
(225) 412-3820
Mailing address
11258 REGENCY AVENUE, HAMMOND, LA 70403
(985) 402-5500
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
10/14/2018
Last updated
10/14/2018
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