Individual
KEVIN D. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
502 S HIGH ST APT D, YELLOW SPRINGS, OH 45387-1565
(937) 287-5353
Mailing address
PO BOX 751, YELLOW SPRINGS, OH 45387-0751
(937) 287-5353
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
0002724
OH
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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