Individual
AMANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 S JT STITES, SALLISAW, OK 74955-9301
(918) 775-7787
(918) 775-0328
Mailing address
210 N JT STITES, SALLISAW, OK 74955-9301
(918) 775-7787
(918) 775-0328
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/25/2018
Last updated
01/25/2018
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