Individual
AVERY GRACE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
911 N GOLIAD ST, ROCKWALL, TX 75087-2230
(469) 458-9021
(866) 693-6509
Mailing address
911 N GOLIAD ST, ROCKWALL, TX 75087-2230
(469) 458-9021
(866) 693-6509
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-391628
TX
Other
Enumeration date
11/15/2024
Last updated
11/15/2024
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