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1952893422
JARRED LAVELL BLAKELY
STOCKTON, CA
NPI
1952893422
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
106S00000X Behavior Technician
(Licence: CA 5439)
Enumeration Date
2018-05-31
Last Update Date
2018-06-16
Business Address
JARRED LAVELL BLAKELY
718 E 7TH ST
STOCKTON, CA 95206-3213
Phone number: 209-453-6903
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Mailing Address
JARRED LAVELL BLAKELY
718 E 7TH ST
STOCKTON, CA 95206-3213
Phone number: 209-453-6903
Copy
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