Individual
LATESHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
119 SAVANNAH ST, MONROE, LA 71202-3921
(318) 331-4459
Mailing address
119 SAVANNAH ST, MONROE, LA 71202-3921
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/08/2017
Last updated
04/08/2017
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