Individual
AUTUMN LYNN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
474 W VERMONT AVE STE 104, ESCONDIDO, CA 92025-6584
(760) 432-9884
Mailing address
9465 FARNHAM ST, SAN DIEGO, CA 92123-1308
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/28/2021
Last updated
06/10/2024
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