Jack Ryan Henderson

NPI #1477203164 in Boulder, Colorado

Provider Information

NPI Number: 1477203164
Entity Type: Individual
Name: Jack Ryan Henderson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Mar 25, 2022
Last Updated: Mar 25, 2022

Practice Location

Address: 4770 BASELINE RD STE 200
City: Boulder
State: Colorado
ZIP Code: 80303-2668
Phone: (970) 982-3476

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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