Individual
DR. JONNIE R. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
141 RUNNYMEDE DR, EAST STROUDSBURG, PA 18301-6958
(570) 476-4279
Mailing address
141 RUNNYMEDE DR, EAST STROUDSBURG, PA 18301-6958
(570) 476-4279
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000000000000000
—
PA
Enumeration date
07/08/2017
Last updated
07/21/2022
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