Individual
ILANA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1 SUNNY MEADOW CT, APT 102, BALTIMORE, MD 21209-1255
(908) 839-7117
Mailing address
405 ALLEGHENY AVE, TOWSON, MD 21204-4256
(908) 839-7117
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
05059
MD
Other
Enumeration date
01/31/2012
Last updated
10/10/2016
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