Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1164760500 |
---|---|
Provider Name | Dr. Kristen B Jackson |
First Address | Columbus, OH 43210-1229 |
Second Address | Columbus, OH 43210-1229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2013 |
Last Update Date | 18/01/2013 |