Individual
DR. JANISSA D JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5401 ROGERS AVE STE 201, FORT SMITH, AR 72903-3763
(479) 242-4560
(479) 242-4561
Mailing address
5401 ROGERS AVE STE 201, FORT SMITH, AR 72903-3763
(479) 242-4560
(479) 242-4561
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
07-01P
AR
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
07-01P
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5A252
BLUECROSS BLUESHIELD
AR
Enumeration date
01/24/2007
Last updated
10/17/2024
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