Individual
MISS ALICIA VASHTI JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
1155 KELLY JOHNSON BLVD, COLORADO SPRINGS, CO 80920-3932
(719) 354-2582
Mailing address
1821 W PLATTE AVE, COLORADO SPRINGS, CO 80904-3560
(719) 717-6894
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
16-17816
CO
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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