Individual provider · NPI-1

Jordyn A Jackson

Behavior Technician · Moreno Valley, CA

NPI number1336837749
StatusActive
Last updated in NPPESApr 25, 2023

Details

NPI
1336837749
Entity type
Individual (NPI-1)
Name
Jordyn A Jackson
Sex
Female
Sole proprietor
Yes
Enumeration date
Apr 25, 2023
Certification date
Apr 25, 2023
Last updated
Apr 25, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106S00000X Behavior Technician––Yes

Practice location

26798 Buckeye Ter
Moreno Valley, CA 92555-3539

Phone 951-563-3107

Mailing address

26798 Buckeye Ter
Moreno Valley, CA 92555-3539

Phone 951-563-3107

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