Individual
JACQULINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1127 N KICKAPOO AVE, SHAWNEE, OK 74801-4845
(405) 214-0116
(877) 334-8552
Mailing address
33207 45TH ST, SHAWNEE, OK 74804-3423
(405) 214-0116
(877) 334-8552
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5594
OK
Other
Enumeration date
12/14/2011
Last updated
03/01/2016
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