Individual
JARRETT RESEAN BLACKMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4310 BURGESS DR, BAKER, LA 70714-2410
(225) 347-4088
Mailing address
4310 BURGESS DR, BAKER, LA 70714-2410
(225) 347-4088
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
011083246
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202620372
—
LA
Enumeration date
05/03/2021
Last updated
05/03/2021
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