Individual
JON R JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
337 FOWLER ST, ROSEBURG, OR 97470
(541) 440-3532
(541) 440-3554
Mailing address
272 MEDICAL LOOP, SUITE E, ROSEBURG, OR 97471
(541) 440-3532
(541) 440-3554
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/10/2008
Last updated
08/10/2015
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