Individual
KAYLA M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAT, NCC
Contact information
Practice address
46 PRINCE ST, ROCHESTER, NY 14607-1023
(585) 730-4828
Mailing address
350 WESTMINSTER RD, ROCHESTER, NY 14607-3233
(917) 843-6105
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
000531
NY
Other
Enumeration date
02/27/2018
Last updated
02/27/2018
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