Individual
CAROL A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 PASEO DEL CANON W, TAOS, NM 87571-6743
(575) 779-6138
Mailing address
110 PASEO DEL CANON W, TAOS, NM 87571-6743
(575) 779-6138
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
090906
NM
Other
Enumeration date
09/22/2011
Last updated
09/22/2011
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