Individual
DR. KAY ELLEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH. D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
012747-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417127945
NPPES
NY
Enumeration date
03/12/2008
Last updated
02/01/2017
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