Individual
DR. ANNE ELIZABETH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1101 COLLEGE AVE, STE 230, SANTA ROSA, CA 95404-3956
(650) 444-3260
Mailing address
712 BANCROFT RD # 771, WALNUT CREEK, CA 94598-1531
(650) 444-3260
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY17785
CA
103TC0700X
Clinical Psychologist
Primary
PSY17785
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY17785
CA
Other
Enumeration date
09/27/2008
Last updated
02/06/2017
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