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Individual

MEGAN JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1502 LIATRIS LN, NORTH POLE, AK 99705-5082
(907) 385-7332
Mailing address
365 KODIAK ST STOP 2000, EIELSON AFB, AK 99702-5379
(907) 385-5733

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
523381
AK

Other

Enumeration date
01/05/2021
Last updated
01/05/2021
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