Lavin Jackson

NPI #1831763598 in Fruitland, New Mexico

Provider Information

NPI Number: 1831763598
Entity Type: Individual
Name: Lavin Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Behavior Technician
Enumeration Date: May 18, 2021
Last Updated: May 18, 2021

Practice Location

Address: N36
City: Fruitland
State: New Mexico
ZIP Code: 87416
Phone: (505) 360-8309

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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