Individual
TONYA SUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5411 COLISEUM BLVD, ALEXANDRIA, LA 71303-3729
(318) 484-2347
Mailing address
3770 MONROE HIGHWAY STE C, PMB 170, PINEVILLE, LA 71360-4170
(318) 880-3044
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
1072
LA
Other
Enumeration date
04/15/2010
Last updated
12/14/2021
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