Individual
MONIKA JAKUBKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
1650 SW 45TH PL, CORVALLIS, OR 97333-1768
(541) 757-8068
(541) 758-1030
Mailing address
1650 SW 45TH PL, CORVALLIS, OR 97333-1768
(541) 757-8068
(541) 758-1030
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128715
—
OR
Enumeration date
04/16/2019
Last updated
04/16/2019
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