Individual
DR. LISA ANN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4955 N BAILEY AVE, AMHERST, NY 14226-1206
(716) 833-0292
(716) 833-0215
Mailing address
332 DAN TROY DR, WILLIAMSVILLE, NY 14221-3514
(716) 839-4658
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
011968
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01474937
—
NY
Enumeration date
03/15/2007
Last updated
07/08/2007
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