Individual
JORDAN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
5604 ELLSWORTH RD, FORT SMITH, AR 72903-3224
(479) 926-4673
Mailing address
PO BOX 10921, FORT SMITH, AR 72917-0921
(479) 926-4673
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
24-332423
AR
Other
Enumeration date
04/03/2024
Last updated
04/03/2024
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