Most Relevant Information
Provider Data
| NPI Number: | 1003067307 |
| Provider Name: | LAURA JACKMAN |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | 180.003361 |
Most Important Dates
| Enumeration Date: | 10/05/2008 |
| Last Updated: | 10/05/2008 |
Provider Practice Location
1415 MAPLE RD
JOLIET
IL
604321442
Practice Location Phone/Fax
| Phone: | 8157350732 |
| Fax: |
Provider Mailing Location
604 LAMBETH LN
NEW LENOX
IL
604519638
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |