Latasha Monique Jackson

NPI #1639938640 in Hephzibah, Georgia

Provider Information

NPI Number: 1639938640
Entity Type: Individual
Name: Latasha Monique Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Mar 13, 2024
Last Updated: Mar 13, 2024

Practice Location

Address: 3912 LAKESIDE PASS
City: Hephzibah
State: Georgia
ZIP Code: 30815-4728
Phone: (706) 804-1499

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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