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Individual

MISHELLE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SUDPT

Contact information

Practice address
1505 KLA-OOK-WA DR, TAHOLAH, WA 98587
(360) 276-8215
Mailing address
PO BOX 219, TAHOLAH, WA 98587-0219
(360) 276-8215

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO-61267571
WA

Other

Enumeration date
10/12/2023
Last updated
10/12/2023
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