Individual
JACLYN BOSWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3101 MAGIC HOLLOW BLVD, VIRGINIA BEACH, VA 23453-3010
(757) 639-2218
Mailing address
3101 MAGIC HOLLOW BLVD, VIRGINIA BEACH, VA 23453-3010
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-22-244585
BACB
—
Enumeration date
11/16/2022
Last updated
11/16/2022
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