Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1073054839 |
---|---|
Provider Name | Aeronda Yuron Jackson |
First Address | Oakland, CA 94607-2205 |
Second Address | Oakland, CA 94607-2205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 13/03/2017 |