Individual
TAWONNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4636 S HARVARD AVE, TULSA, OK 74135-2908
(918) 382-7300
Mailing address
5735 E 62ND PL, TULSA, OK 74136-2712
(918) 732-9684
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/06/2015
Last updated
04/06/2015
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