Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1164990826 |
---|---|
Provider Name | Miss Brianna Mo'nique Jackson |
First Address | Monroe, LA 71201-3803 |
Second Address | Monroe, LA 71202-2030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2018 |
Last Update Date | 10/11/2018 |