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General NPI Number Information
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NPI Number | 1992940100
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Entity Type | Individual
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Provider Name | ELIZABETH KOLB-JACKSON
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Gender | Female
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 911 E ATLANTIC BLVD STE 108A
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City | POMPANO BEACH
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State | FL
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Zip | 33060-7372
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Country | US
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Telephone | 954-941-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 3325 PINEWALK DR N APT 201
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City | MARGATE
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State | FL
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Zip | 33063-7827
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Country | US
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Telephone | 803-972-4728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133000518
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-14939
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License Number State |
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