Individual
MRS. LAURIE RENE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
517 W NORTHERN LIGHTS BLVD, ANCHORAGE, AK 99503-2503
(907) 242-0847
Mailing address
1510 WATERWOOD CIR, ANCHORAGE, AK 99507-2183
(907) 242-0847
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/23/2018
Last updated
07/23/2018
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