Most Relevant Information
Provider Data
| NPI Number: | 1003459934 |
| Provider Name: | STEPHANIE DENISE JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 253J00000X |
| Specialty: | Foster Care Agency |
| License Number: | 9911474 |
Most Important Dates
| Enumeration Date: | 10/23/2019 |
| Last Updated: | 03/10/2020 |
Provider Practice Location
22321 W MORNING GLORY ST
BUCKEYE
AZ
853267181
Practice Location Phone/Fax
| Phone: | 5032097572 |
| Fax: | 6024554624 |
Provider Mailing Location
22321 W MORNING GLORY ST
BUCKEYE
AZ
853267181
Provider Mailing Phone/Fax
| Phone: | 5032097572 |
| Fax: | 6024554624 |