Latrice Jackson
Behavior Technician in Indianapolis, IN. Individual provider (NPI-1).
NPI number1164095279
StatusActive
Last updated in NPPESJul 19, 2021
Details
- NPI
- 1164095279
- Entity type
- Individual (NPI-1)
- Name
- Latrice Jackson
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 19, 2021
- Certification date
- Jul 19, 2021
- Last updated
- Jul 19, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
3731 Guion RdIndianapolis, IN 46222-1617
Phone 317-849-5437
Mailing address
3731 Guion RdIndianapolis, IN 46222-1617
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