Individual
FREDRICCA JAZZMAN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
8481 REGAL BEND DR, OLIVE BRANCH, MS 38654-4416
(901) 606-5038
Mailing address
8481 REGAL BEND DR, OLIVE BRANCH, MS 38654-4416
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
12044081
TN
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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