Individual
MS. KIMBERLY JACKOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
152 N POWER RD STE 2, MESA, AZ 85205-8436
(480) 542-2525
Mailing address
152 N POWER RD STE 2, MESA, AZ 85205-8436
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
LAC-16779
AZ
101YP2500X
Professional Counselor
Primary
—
—
102L00000X
Psychoanalyst
—
—
Other
Enumeration date
01/04/2021
Last updated
01/04/2021
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