Individual
ROBERT TYRONE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
120 S 3RD ST, YAKIMA, WA 98901-2875
(509) 571-1537
Mailing address
120 S 3RD ST, YAKIMA, WA 98901-2875
(509) 571-1537
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CG-70001630
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91-0755984
—
WA
Enumeration date
09/16/2025
Last updated
09/16/2025
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