Individual
MARRY EMMA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHS ASSOC
Contact information
Practice address
5290 COBBLEGATE DRIVE, 7TH FLOOR, MORAINE, OH 45439-4540
(937) 293-2510
Mailing address
11 W MONUMENT AVE FL 7, DAYTON, OH 45402-1274
(937) 461-4300
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0301947
—
OH
Enumeration date
01/04/2022
Last updated
01/04/2022
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