Individual
JADA RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
329 GARRISONS LAKE BLVD, SMYRNA, DE 19977-4837
(302) 803-2210
(302) 389-6907
Mailing address
259 TRACER DR, CLAYTON, DE 19938-3807
(267) 997-5258
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1816334
DE
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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