Individual
KEWUAN DESHAUN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4880 N SABINO CANYON RD, APT 14160, TUCSON, AZ 85750-7006
(520) 818-4318
Mailing address
4880 N SABINO CANYON RD, APT 14160, TUCSON, AZ 85750-7006
(520) 818-4318
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
1490923
AZ
Other
Enumeration date
08/05/2009
Last updated
08/05/2009
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