Individual
KIM N JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 N HOWARD ST STE 300, BALTIMORE, MD 21218-5909
(443) 438-6742
Mailing address
1900 N HOWARD ST STE 300, BALTIMORE, MD 21218-5909
(443) 438-6742
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
G10538
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
383876389
—
MD
Enumeration date
06/27/2018
Last updated
06/27/2018
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