Individual
STACY LATRICE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6817 GREENWOOD AVE. N., SEATTLE, WA 98103-8801
(725) 351-0871
Mailing address
6817 GREENWOOD AVE N, SEATTLE, WA 98103-8801
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00024477
WA
Other
Enumeration date
08/29/2007
Last updated
12/18/2008
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