Salem Isabella Derdock
Behavior Technician in Jacksonville, FL. Individual provider (NPI-1).
NPI number1124986534
StatusActive
Last updated in NPPESJan 13, 2026
Details
- NPI
- 1124986534
- Entity type
- Individual (NPI-1)
- Name
- Salem Isabella Derdock
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 13, 2026
- Certification date
- Jan 13, 2026
- Last updated
- Jan 13, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | FL | Yes |
Practice location
12276 San Jose Blvd Ste 508Jacksonville, FL 32223-8618
Phone 904-886-3228 · Fax 904-485-8876
Mailing address
12276 San Jose Blvd Ste 508Jacksonville, FL 32223-8618
Phone 904-886-3228 · Fax 904-485-8876
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