Most Relevant Information
Provider Data
| NPI Number: | 1003295809 |
| Provider Name: | KATHERINE JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/26/2015 |
| Last Updated: | 07/11/2024 |
Provider Practice Location
17427 W WANDERING CREEK RD
GOODYEAR
AZ
853385735
Practice Location Phone/Fax
| Phone: | 2532080756 |
| Fax: |
Provider Mailing Location
17427 W WANDERING CREEK RD
GOODYEAR
AZ
853385735
Provider Mailing Phone/Fax
| Phone: | 2532080756 |
| Fax: |