Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2837-057 | WI |
NPI | 1063741064 |
---|---|
Provider Name | Dr. Julie Ann Jackson |
First Address | Milwaukee, WI 53295-0001 |
Second Address | Milwaukee, WI 53295-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2009 |
Last Update Date | 22/12/2009 |