Individual
MR. BRANDON SCOTT BACKUS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 3RD AVE, SEATTLE, WA 98104-2304
(206) 464-1570
Mailing address
515 3RD AVE, SEATTLE, WA 98104-2304
(206) 464-1570
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG61445547
WA
101Y00000X
Counselor
—
—
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
—
WA
Other
Enumeration date
06/15/2017
Last updated
11/17/2025
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