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Individual

TAMMY J JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LICENSED PSYCHOLOGIS

Contact information

Practice address
1272 NE WINDSOR DR, LEES SUMMIT, MO 64086-5594
(816) 246-4465
Mailing address
1272 NE WINDSOR DR, LEES SUMMIT, MO 64086-5594
(816) 246-4465

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
01757
MO
103TC1900X
Counseling Psychologist
01757
MO
103TC2200X
Clinical Child & Adolescent Psychologist
01757
MO

Other

Enumeration date
12/22/2006
Last updated
10/11/2019
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