Individual
MRS. LARA LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S.
Contact information
Practice address
10440 INDIAN CREEK RD S, INDIANAPOLIS, IN 46259-1451
(317) 803-8112
(317) 803-8197
Mailing address
10440 INDIAN CREEK RD S, INDIANAPOLIS, IN 46259-1451
(317) 803-8112
(317) 803-8197
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1482318
IN
Other
Enumeration date
10/21/2024
Last updated
10/21/2024
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