Individual
DR. MICHELLE A JACKSON
Active
Individual
DR. MICHELLE A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY004033
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
01
—
685661
TUFTS
MA
Enumeration date
07/22/2010
Last updated
01/31/2018
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