Individual
ROBERT LEON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1201 S VETERANS PKWY, SUITE B, SPRINGFIELD, IL 62704-6321
(217) 793-2770
Mailing address
16 LONGBOW LN, SPRINGFIELD, IL 62704-5324
(217) 787-3143
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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