Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1043556087 |
---|---|
Provider Name | Antoinette S Jackson |
First Address | North Las Vegas, NV 89032-8104 |
Second Address | North Las Vegas, NV 89032-8104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2012 |
Last Update Date | 19/12/2012 |