Jaeliah Lane

NPI #1174111975 in O Fallon, Illinois

Provider Information

NPI Number: 1174111975
Entity Type: Individual
Name: Jaeliah Lane
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Behavior Technician
Enumeration Date: Jan 6, 2021
Last Updated: Jan 6, 2021

Practice Location

Address: 6 EAGLE CTR STE 1
City: O Fallon
State: Illinois
ZIP Code: 62269-1945
Phone: (618) 206-8816

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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