Individual
DR. SHANNON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
150 NORTH MAIN ST, ECHN HEALTH SERVICES, MANCHESTER, CT 06040-4188
(860) 647-6832
(860) 647-6831
Mailing address
150 NORTH MAIN STREET, ECHN ADULT AMBULATORY SERVICES, MANCHESTER, CT 06040-4188
(860) 647-6832
(860) 647-6831
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
00297
CT
Other
Enumeration date
09/30/2009
Last updated
09/30/2009
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