Individual
PATRICK DIOR JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5111 S 3RD ST, LOUISVILLE, KY 40214-2601
(502) 690-1511
Mailing address
811 STONEBENCH CIR, JEFFERSONVLLE, IN 47130-4220
(812) 557-5365
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
201114318
KY
Other
Enumeration date
08/28/2019
Last updated
08/28/2019
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