Most Relevant Information
Provider Data
| NPI Number: | 1003532854 |
| Provider Name: | KASSIDY S JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/13/2022 |
| Last Updated: | 10/13/2022 |
Provider Practice Location
3242 E MAIN ST STE 2
COLUMBUS
OH
432133807
Practice Location Phone/Fax
| Phone: | 6145004150 |
| Fax: | 6145004150 |
Provider Mailing Location
3242 E MAIN ST STE 2
COLUMBUS
OH
432133807
Provider Mailing Phone/Fax
| Phone: | |
| Fax: | 6145004150 |