Individual
EVAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PC-CR
Contact information
Practice address
1101 N VANDEMARK RD, SIDNEY, OH 45365-3567
(937) 492-8080
Mailing address
1101 N VANDEMARK RD, SIDNEY, OH 45365-3567
(937) 492-8080
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C09000163
OH
Other
Enumeration date
03/24/2015
Last updated
03/24/2015
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