Individual
MARSHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2640 FOREST HILL BLVD, WEST PALM BEACH, FL 33406-5931
(561) 616-8411
(561) 616-8412
Mailing address
3850 MAX PL APT 204, BOYNTON BEACH, FL 33436-2062
(561) 523-8498
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386197978
—
FL
Enumeration date
07/29/2016
Last updated
04/12/2019
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