Jackson, Diane

Jackson, Diane is an sole proprietor health care provider with primary practice located at 8108 Se Coconut St , Hobe Sound FL 33455-4008. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Technologists, Technicians & Other Technical Service Providers / Technician, Other. Behavioral Health & Social Service Providers / Behavior Technician is her primary health care specialty. Jackson, Diane can be contacted via phone (772) 349-6317.

Contact Information

Primary practice address
8108 Se Coconut St Hobe Sound FL 33455-4008
Phone: (772) 349-6317
Fax: (772) 675-9100
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X RBT-16-15265 Florida
Technologists, Technicians & Other Technical Service Providers / Technician, Other 247200000X
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X

Profile Details

NPI number 1033403829
LBN Legal business name Jackson, Diane
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 8th, 2011
Last updated Apr 4th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033403829 NPPES
Florida MEDICAID 1033403829

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