Individual
ANDREA MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
170 MELTON RD, CRESWELL, OR 97426-9453
(541) 306-6456
Mailing address
170 MELTON RD, CRESWELL, OR 97426-9453
(541) 306-6456
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3120
OR
Other
Enumeration date
06/15/2017
Last updated
10/30/2024
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