Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003003690 |
---|---|
Provider Name | Margaret Jackson |
First Address | Fort Sam Houston, TX 78234-4501 |
Second Address | Fort Sam Houston, TX 78234-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 27/09/2007 |