Individual
COLLIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
1813 WILLOW ST STE 4D, VINCENNES, IN 47591-4279
(812) 322-0313
Mailing address
PO BOX 668, BLOOMINGTON, IN 47402-0668
(812) 322-0313
(812) 610-1814
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-346951
IN
Other
Enumeration date
05/17/2024
Last updated
05/17/2024
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