Individual
JEROME ALEXANDER-TERRELL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9680 W NORTHERN AVE UNIT 2311, PEORIA, AZ 85345-4655
(989) 980-8286
(602) 455-4626
Mailing address
9680 W NORTHERN AVE UNIT 2311, PEORIA, AZ 85345-4655
(989) 980-8286
(602) 455-4626
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
10195508
AZ
385HR2055X
Child Mental Illness Respite Care
10195508
AZ
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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