Organization
C WESLEY JACKSON JR PHD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
C WESLEY JACKSON JR. PHD (PRESIDENT OWNER)
(216) 321-9355
Entity
Organization
Contact information
Practice address
2980 WASHINGTON BLVD, CLEVELAND HEIGHTS, OH 44118-2450
(216) 321-9355
(216) 932-3341
Mailing address
2980 WASHINGTON BLVD, CLEVELAND HEIGHTS, OH 44118-2450
(216) 321-9355
(216) 932-3341
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
000519
MI
103TC0700X
Clinical Psychologist
Primary
474
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0253309
—
OH
Enumeration date
04/12/2007
Last updated
07/30/2012
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