Individual
KRISTYNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 W 8TH ST, ANDERSON, IN 46016-2659
(765) 810-0830
Mailing address
10395 E 500 S, UPLAND, IN 46989-9447
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34009745A
IN
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/08/2015
Last updated
07/01/2022
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