Organization
COGNITIVE DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHELLCY JACKSON M.S. (MHP)
(318) 418-0329
Entity
Organization
Contact information
Practice address
316 WOODALE DR APT 11, MONROE, LA 71203-2712
(318) 600-6045
Mailing address
316 WOODALE DR APT 11, MONROE, LA 71203-2712
(318) 600-6045
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
10/03/2016
Last updated
10/03/2016
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