Individual
MS. ANNA L JACKARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LADAC
Contact information
Practice address
15 OAK ST, CLAYTON, NM 88415-2530
(505) 374-9533
(505) 374-8149
Mailing address
PO BOX 541, CLAYTON, NM 88415-0541
(505) 374-9533
(505) 374-8149
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3548
NM
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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