Individual
KAYLA ANN JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
US 491, SHIPROCK, NM 87420
(505) 419-0294
Mailing address
PO BOX 5036, SHIPROCK, NM 87420-5036
(505) 419-0294
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
SWB-2023-0550
NM
Other
Enumeration date
08/10/2023
Last updated
09/08/2023
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