Individual
TAMMY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, LBA, MBA
Contact information
Practice address
150 VICTORIA DR, CHESHIRE, CT 06410-7126
(203) 819-2025
Mailing address
150 VICTORIA DR, CHESHIRE, CT 06410-7126
(203) 819-2025
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-09-5870
CT
Other
Enumeration date
07/18/2008
Last updated
02/08/2021
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