Individual
WAVERLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4085 M ST, WASHOUGAL, WA 98671-8977
(360) 904-5192
Mailing address
4085 M ST, WASHOUGAL, WA 98671-8977
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/02/2026
Last updated
04/02/2026
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