Individual
JEFFREY N JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
914 E BROADWAY, LOUISVILLE, KY 40204-1037
(502) 589-8600
(502) 589-8771
Mailing address
101 W MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1423
(502) 589-8600
(502) 589-8771
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1279
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100283870
—
KY
Enumeration date
07/12/2006
Last updated
03/05/2015
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