Individual
SUZANNE ELIZABETH JACKIW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(505) 471-5006
(505) 820-9220
Mailing address
1876 PLAZA DEL SUR DR APT 110C, SANTA FE, NM 87505-6061
(815) 501-6869
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/13/2010
Last updated
08/13/2010
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