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1568080133
CANON PEYTON JACKSON
BOWLING GREEN, KY
NPI
1568080133
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
(Licence: KY RBT-20-115930)
Enumeration Date
2020-07-10
Last Update Date
2020-07-10
Business Address
CANON PEYTON JACKSON BS
2427 RUSSELLVILLE RD
BOWLING GREEN, KY 42101-3980
Phone number: 270-936-7472
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Mailing Address
CANON PEYTON JACKSON BS
3500 DEPAUW BLVD STE 3070
INDIANAPOLIS, IN 46268-6135
Phone number: 855-324-0885
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