Individual
TARA M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
104 G CORUM LN, AUBURN, KY 42206-5000
(270) 847-7004
(270) 542-2519
Mailing address
104 G CORUM LN, AUBURN, KY 42206-5000
(270) 847-7004
(270) 542-2519
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
04/29/2020
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