Individual
KIMBERLY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11960 WESTLINE INDUSTRIAL DR, STE 201, SAINT LOUIS, MO 63146-3209
(866) 433-9555
Mailing address
1303 ANDREW DR, SAINT LOUIS, MO 63122-1802
(314) 922-6289
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
197095
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197095
EDUCATOR ID
MO
Enumeration date
11/01/2016
Last updated
11/01/2016
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