Individual
DONNITA KAYE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1210 SOUTH TRACE, AUSTIN, TX 78745
(512) 888-5985
Mailing address
1210 SOUTH TRACE, AUSTIN, TX 78745
(512) 888-5985
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/19/2012
Last updated
09/12/2013
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