Individual
GRACE ELIZABETH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4441 E CESAR CHAVEZ BLVD, FRESNO, CA 93702-3604
(559) 600-9059
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036154094
IL
2084P0800X
Psychiatry Physician
12228A
WY
2084P0800X
Psychiatry Physician
15320
NV
2084P0800X
Psychiatry Physician
200200922
NC
2084P0800X
Psychiatry Physician
30325
WV
2084P0800X
Psychiatry Physician
46710
AZ
2084P0800X
Psychiatry Physician
63217
TN
2084P0800X
Psychiatry Physician
C56001
CA
2084P0800X
Psychiatry Physician
D0090940
MD
2084P0800X
Psychiatry Physician
MD-17101
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5913321
—
NC
05
—
765156
—
AZ
Enumeration date
10/12/2006
Last updated
12/09/2025
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