Individual
JOHN MARK JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3470 BALTIMORE AVE, PUEBLO, CO 81008-1520
(719) 545-1181
Mailing address
208 CIRCLE DR W, CANON CITY, CO 81212-2439
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/08/2020
Last updated
01/08/2020
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