Individual
ARIELLE LASHAY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
167 POLK ST STE 300, WATERTOWN, NY 13601-2770
(315) 782-7445
(315) 779-1184
Mailing address
PO BOX 6550, WATERTOWN, NY 13601-6550
(315) 782-7445
(315) 779-1184
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3372621
—
NY
Enumeration date
02/21/2019
Last updated
02/21/2019
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