Teresa L Jackson
Family Doctor - Addiction Medicine
17880 147th St Se
Monroe
, Washington 98272-1014
Teresa L Jackson
Family Doctor - Addiction Medicine
17880 147th St Se
Monroe
, Washington 98272-1014
(360) 794-1493
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About
Features
Specialties
- Family Doctor - Addiction Medicine
Languages spoken
- English
Location
First Address
- Teresa L Jackson
- 17880 147th St Se
- Monroe, WA
- Zip : 98272-1014
- Fax : (360) 794-1493
- Phone : (360) 794-1405
Second Address
- Teresa L Jackson
- 17880 147th St Se
- Monroe, WA
- Zip : 98272-1014
- Fax : (360) 794-1493
- Phone : (360) 794-1405
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QA0401X | Family Doctor - Addiction Medicine | MD60822145 | WA |
National Provider Identifier
| NPI | 1700982444 |
|---|---|
| Provider Name | Teresa L Jackson |
| First Address | Monroe, WA 98272-1014 |
| Second Address | Monroe, WA 98272-1014 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 16/09/2006 |
| Last Update Date | 17/01/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 2099880 | (05) | WA |
| 2Z1286 | HEALTHNET (01) | AZ |
| 851685 | (05) | AZ |
| AZ0789290 | BLUE CROSS BLUE SHIELD (01) | AZ |
| H50049 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.