Individual
JACKSON LEE HAVERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22410 BENSON RD SE, BENSON HEIGHTS REHAB CENTER, KENT, WA 98031-9509
(206) 286-8352
Mailing address
10611 CANYON RD E, PMB 322, PUYALLUP, WA 98373-4256
(206) 286-8352
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
00030718
WA
Other
Enumeration date
03/02/2007
Last updated
07/29/2008
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