Latayvia Sheris Jackson

NPI #1225579824 in Astoria, New York

Provider Information

NPI Number: 1225579824
Entity Type: Individual
Name: Latayvia Sheris Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Mar 15, 2017
Last Updated: Mar 15, 2017

Practice Location

Address: 35-34 21STREETAPT#1H
City: Astoria
State: New York
ZIP Code: 11106
Phone: (646) 240-0903

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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