Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1114514544 |
---|---|
Provider Name | Unique Jackson |
First Address | Owings Mills, MD 21117-3249 |
Second Address | Owings Mills, MD 21117-3249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2020 |
Last Update Date | 31/12/2020 |