Individual
JACK ALLEN STATTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
2515 PARAGON DR APT J, COLORADO SPRINGS, CO 80918-6915
(985) 377-2089
Mailing address
2515 PARAGON DR APT J, COLORADO SPRINGS, CO 80918-6915
(985) 377-2089
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/17/2024
Last updated
05/17/2024
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