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1255045704
LATRICE NICOLE JACKSON
DEARBORN, MI
NPI
1255045704
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2023-01-10
Last Update Date
2023-01-10
Business Address
LATRICE NICOLE JACKSON
2021 MONROE ST STE 304
DEARBORN, MI 48124-2926
Phone number: 517-245-4778
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Mailing Address
LATRICE NICOLE JACKSON
PO BOX 12279
LANSING, MI 48901-2279
Phone number: 517-245-4778
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