Individual
STEPHANIE DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22321 W MORNING GLORY ST, BUCKEYE, AZ 85326-7181
(503) 209-7572
(602) 455-4624
Mailing address
22321 W MORNING GLORY ST, BUCKEYE, AZ 85326-7181
(503) 209-7572
(602) 455-4624
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
9911474
AZ
385HR2055X
Child Mental Illness Respite Care
3311474
AZ
Other
Enumeration date
10/23/2019
Last updated
03/10/2020
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