Individual
PATRICK JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
918 EISENHOWER DR, ROCK SPRINGS, WY 82901-4449
(307) 399-1793
Mailing address
918 EISENHOWER DR, ROCK SPRINGS, WY 82901-4449
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-78853.
WY
Other
Enumeration date
02/19/2019
Last updated
02/19/2019
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