Provider Demographics
NPI:1104658988
Name:JACKSON, KIRAH ALANA (MS,BCBA,LBA)
Entity type:Individual
Prefix:
First Name:KIRAH
Middle Name:ALANA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS,BCBA,LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 RUE COLETTE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-5430
Mailing Address - Country:US
Mailing Address - Phone:504-520-9449
Mailing Address - Fax:
Practice Address - Street 1:1215 PRYTANIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-4357
Practice Address - Country:US
Practice Address - Phone:504-322-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-871103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst