Individual
CATHERINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1651 GALISTEO ST STE 7, SANTA FE, NM 87505-4752
(505) 988-4327
(505) 988-4328
Mailing address
5000 CHESHIRE PKWY N, PLYMOUTH, MN 55446-4203
(763) 268-4000
(763) 268-4017
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
1030
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1030
STATE LICENSE NUMBER
NM
01
—
532
STATE HEARING AID DISPENS
NM
05
—
K2469
—
NM
Enumeration date
05/10/2007
Last updated
01/02/2013
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