Most Relevant Information
Provider Data
| NPI Number: | 1003525593 |
| Provider Name: | ALEXA JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/23/2022 |
| Last Updated: | 11/23/2022 |
Provider Practice Location
3361 36TH ST SE
KENTWOOD
MI
495122809
Practice Location Phone/Fax
| Phone: | 6167261909 |
| Fax: |
Provider Mailing Location
3361 36TH ST SE
KENTWOOD
MI
495122809
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |