Individual
ALEXANDRIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2620 FORUM BLVD STE E, COLUMBIA, MO 65203-5454
(417) 501-4161
(417) 627-5330
Mailing address
2620 FORUM BLVD STE E, COLUMBIA, MO 65203-5454
(417) 501-4161
(417) 627-5330
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/29/2022
Last updated
03/29/2022
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