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NPI Code Detail

MEDICARE: MS. ALECIA ERIENNE JACKSON

MEDICARE: MS. ALECIA ERIENNE JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1497026256
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALECIA ERIENNE JACKSON
Provider Business Mailing Address
First Line : 3106 GREENDALE ST.
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121
Country : US
Telephone Number : 702-882-9227
Fax Number :
Provider Business Practice Location Address
First Line : 3106 GREENDALE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-2715
Country : US
Telephone Number : 702-882-9227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2012
Last Update Date : 01/25/2012

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