Individual
CHANTRA-LEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4201 DEAN LAKES BLVD STE 160, SHAKOPEE, MN 55379-2863
(612) 509-6681
Mailing address
4201 DEAN LAKES BLVD STE 160, SHAKOPEE, MN 55379-2863
(612) 509-6681
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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