Individual
JORDAN CHANTILOPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 GLENVIEW DR, CINNAMINSON, NJ 08077-2135
(856) 617-0486
Mailing address
19 GLENVIEW DR, CINNAMINSON, NJ 08077-2135
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
23-296110
NJ
Other
Enumeration date
01/11/2024
Last updated
01/11/2024
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