Most Relevant Information
Provider Data
| NPI Number: | 1003516295 |
| Provider Name: | JASMINE KIARA JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/06/2023 |
| Last Updated: | 03/06/2023 |
Provider Practice Location
59 AUDUBON RD
TEANECK
NJ
076665526
Practice Location Phone/Fax
| Phone: | 9177515197 |
| Fax: |
Provider Mailing Location
59 AUDUBON RD
TEANECK
NJ
076665526
Provider Mailing Phone/Fax
| Phone: | 9177515197 |
| Fax: |