Individual
AUTUM L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1318 WAUKEGAN RD, GLENVIEW, IL 60025-3022
(817) 442-9022
Mailing address
2104 GREENBRIAR DR, SOUTHLAKE, TX 76092-8355
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-16-16039
TX
Other
Enumeration date
03/29/2023
Last updated
07/20/2023
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