Most Relevant Information
Provider Data
| NPI Number: | 1003646621 |
| Provider Name: | BRANDON JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/07/2024 |
| Last Updated: | 08/07/2024 |
Provider Practice Location
3270 N BEND RD
CINCINNATI
OH
452397611
Practice Location Phone/Fax
| Phone: | 4106458666 |
| Fax: |
Provider Mailing Location
1715 GWYNN OAK AVE
GWYNN OAK
MD
212075280
Provider Mailing Phone/Fax
| Phone: | 4433148564 |
| Fax: |