Individual
MS. STACY ANN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N/A
Contact information
Practice address
3762 AMBER ST NE APT 102, SALEM, OR 97301-6883
(971) 239-2390
Mailing address
3400 STATE ST STE 750, SALEM, OR 97301-5861
(971) 273-7502
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/15/2018
Last updated
11/15/2018
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