Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 4284 | CA |
NPI | 1164663340 |
---|---|
Provider Name | Nancy Jackson |
First Address | San Francisco, CA 94117-2242 |
Second Address | San Francisco, CA 94117-2242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2009 |
Last Update Date | 17/03/2009 |