Individual
TAWANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S, NCSP
Contact information
Practice address
360 BLAIR LANE, DOOR 13, BOLINGBROOK, IL 60615
(630) 679-1210
Mailing address
360 BLAIR LANE, DOOR 13, BOLINGBROOK, IL 60440
(630) 679-1210
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
2403396
IL
Other
Enumeration date
08/24/2017
Last updated
08/24/2017
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