Individual
WHITNEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 N 3RD ST, LEESVILLE, LA 71446-4014
(337) 239-3334
Mailing address
400 SOMERSET DR APT 402C, DERIDDER, LA 70634-2864
(337) 343-1175
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/06/2021
Last updated
04/06/2021
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