Individual
CHELSIE JOLENE JEAKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1510 S KANSAS AVE, ROSWELL, NM 88203-3730
(775) 399-4817
Mailing address
1510 S KANSAS AVE, ROSWELL, NM 88203-3730
(775) 399-4817
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3204638658
—
PA
Enumeration date
03/29/2020
Last updated
03/29/2020
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