Individual
DR. COLLEEN MAGUIRE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
703 3RD ST, WEST LAFAYETTE, IN 47907-2081
(765) 494-6995
Mailing address
703 3RD ST, WEST LAFAYETTE, IN 47907-2081
(765) 494-6995
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20042613A
IN
103TC1900X
Counseling Psychologist
Primary
20042613A
IN
Other
Enumeration date
10/03/2013
Last updated
04/28/2015
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