Individual
JERROLD ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 RIVERWALK WAY, IRMO, SC 29063-9321
(803) 608-2461
Mailing address
104 RIVERWALK WAY, IRMO, SC 29063-9321
(803) 608-2461
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/29/2024
Last updated
11/29/2024
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