Individual
ERICA SUSANNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP/T
Contact information
Practice address
1505 KLA-OOK WA DRIVE, TAHOLAH, WA 98587
(360) 276-8211
Mailing address
PO BOX 608, AMANDA PARK, WA 98526-0608
(360) 276-8211
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61691434
WA
Other
Enumeration date
02/05/2026
Last updated
02/05/2026
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