Individual
AMIE KATHLEEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1130 GARBRY RD, PIQUA, OH 45356-8217
(513) 941-4999
(513) 694-0168
Mailing address
6460 HARRISON AVE STE 200, CINCINNATI, OH 45247-7958
(513) 941-4999
(513) 694-0168
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.176328
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.179912
OH
163W00000X
Registered Nurse
RN.376287
OH
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.023408
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0311836
—
OH
Enumeration date
08/17/2018
Last updated
12/13/2024
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