Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist | 19474537 | TX |
NPI | 1720440332 |
---|---|
Provider Name | Traneka Jackaon |
First Address | Pearland, TX 77581-5306 |
Second Address | Pearland, TX 77581-5306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 23/03/2016 |