Individual
STEPHANIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2708 NE 14TH ST APT 5, POMPANO BEACH, FL 33062-3564
(888) 880-9270
Mailing address
1602 JACKSON ST, LAKE CHARLES, LA 70601-2462
(337) 488-5713
(337) 564-0213
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/09/2013
Last updated
07/09/2013
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