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Jacquie Dominguez

Behavior Technician in Kentwood, MI. Individual provider (NPI-1).

NPI number1962003137
StatusActive
Last updated in NPPESNov 4, 2020

Details

NPI
1962003137
Entity type
Individual (NPI-1)
Name
Jacquie Dominguez
Sex
Female
Sole proprietor
No
Enumeration date
Nov 4, 2020
Certification date
Nov 4, 2020
Last updated
Nov 4, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106S00000X Behavior Technician––Yes

Practice location

3361 36th St Se
Kentwood, MI 49512-2809

Phone 424-374-6928

Mailing address

3361 36th St Se
Kentwood, MI 49512-2809

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