Individual
CASSANDRA FAITH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4100 BARBARA LOOP SE, RIO RANCHO, NM 87124-1000
(505) 702-8547
Mailing address
4916 HAYWORTH HILLS DR NE, RIO RANCHO, NM 87144-8667
(505) 339-7360
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1460
NM
Other
Enumeration date
09/12/2022
Last updated
02/24/2025
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