Individual
SONYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5946 E FAIRLANE CT, BATON ROUGE, LA 70812-1817
(225) 239-8027
Mailing address
5946 E FAIRLANE CT, BATON ROUGE, LA 70812-1817
(225) 239-8027
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
LA
Enumeration date
03/01/2017
Last updated
04/30/2018
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