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 |