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Individual

JASON ALLEN JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CPSW

Contact information

Practice address
912 1ST ST NW, ALBUQUERQUE, NM 87102-2355
(505) 224-9777
(505) 224-9779
Mailing address
912 1ST ST NW, ALBUQUERQUE, NM 87102-2355
(505) 224-9777
(505) 224-9779

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
816
NM

Other

Enumeration date
04/15/2019
Last updated
04/15/2019
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