Individual
JACKSON L STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
110 CAMPUS DR, BRADFORD, PA 16701-1982
(814) 362-6535
Mailing address
110 CAMPUS DR, BRADFORD, PA 16701-1982
(814) 362-6535
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS004481L
PA
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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