Most Relevant Information
Provider Data
| NPI Number: | 1003484064 |
| Provider Name: | JACOB SHAIN |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/16/2021 |
| Last Updated: | 06/16/2021 |
Provider Practice Location
17235 N 75TH AVE
SUITE G-120
GLENDALE
AZ
853080831
Practice Location Phone/Fax
| Phone: | 3039898169 |
| Fax: |
Provider Mailing Location
17235 N 75TH AVE
SUITE G-120
GLENDALE
AZ
853080831
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |