Individual
MS. THEODORA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
540 55TH STREET, N.E., WASHINGTON, DC 20019
(202) 939-2030
(202) 388-3849
Mailing address
540 55TH STREET, N.E., WASHINGTON, DC 20019
(202) 939-2030
(202) 388-3849
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
CERTIFIED
DC
Other
Enumeration date
10/09/2013
Last updated
10/09/2013
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