Individual
MELISSA REYES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
3839 W CAMELBACK RD, PHOENIX, AZ 85019-2512
(602) 764-6052
Mailing address
8816 W LAS PALMARITAS DR, PEORIA, AZ 85345-7808
(602) 764-6052
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
897796
—
AZ
Enumeration date
05/24/2007
Last updated
07/26/2007
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