Individual
GWENDOLEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2020 PINTO LN, LAS VEGAS, NV 89106-4019
(702) 868-2901
Mailing address
2020 PINTO LN, LAS VEGAS, NV 89106-4019
(702) 868-2901
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2600466410
—
NV
Enumeration date
06/14/2018
Last updated
06/14/2018
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