Individual
MRS. HEATHER VANCE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.W.
Contact information
Practice address
2600 E 18TH ST, CHEYENNE, WY 82001-5511
(307) 633-7293
Mailing address
1312 WEATHERBY DR, CHEYENNE, WY 82007-9113
(307) 633-7293
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/02/2010
Last updated
08/02/2010
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