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1164952644
BRANDON SCOTT BACKUS JACKSON
BREMERTON, WA
NPI
1164952644
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
Additional Taxonomies
106S00000X Behavior Technician
Enumeration Date
2017-06-15
Last Update Date
2023-06-21
Business Address
BRANDON SCOTT BACKUS JACKSON
5455 ALMIRA DR NE
BREMERTON, WA 98311-8330
Phone number: 360-373-5031
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Mailing Address
BRANDON SCOTT BACKUS JACKSON
5455 ALMIRA DR NE
BREMERTON, WA 98311-8330
Phone number: 360-373-5031
Copy
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