Provider Information for 1326516402
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BONNIE ELLEN JACKMAN LICSW
Sex: Female
NPI: 1326516402
Last Updated: 2018-11-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1326516402 | ||||||||
| Enumeration Date | 2018-11-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 70 ROUTE 28 ORLEANS, MA 02653-3307 United States Phone: 508-255-0016 | Fax: | ||||||||
| Primary Practice Address | 70 ROUTE 28 ORLEANS, MA 02653-3307 United States Phone: 508-255-0016 | Fax: | ||||||||
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