Individual
DANETTE P JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D., CCC-A
Contact information
Practice address
7525 CUSTER ROAD W., LAKEWOOD, WA 98499
(253) 476-7327
(253) 476-0585
Mailing address
7525 CUSTER ROAD W., LAKEWOOD, WA 98499
(253) 476-7327
(253) 476-0585
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
LD00001210
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0196115
LABOR AND INDUSTRIES
WA
05
—
7127665
—
WA
05
—
9058553
—
WA
Enumeration date
03/23/2007
Last updated
06/30/2022
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