Gwendolyn Rachelle Jackson I

NPI #1265143978 in Upperco, Maryland

Provider Information

NPI Number: 1265143978
Entity Type: Individual
Name: Gwendolyn Rachelle Jackson I
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Behavior Technician
Enumeration Date: Dec 13, 2022
Last Updated: Dec 13, 2022

Practice Location

Address: 23 THOMAS SHILLING CT
City: Upperco
State: Maryland
ZIP Code: 21155-9334
Phone: (443) 901-6739

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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