Provider Information for 1417244286
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Ms. GWENDOLYN SANDRA JACKSON L.C.S.W.
Sex: Female
NPI: 1417244286
Last Updated: 2011-06-30
Certification Date:
Certification Date:
Details
Name | Value | ||||||||
---|---|---|---|---|---|---|---|---|---|
NPI | 1417244286 | ||||||||
Enumeration Date | 2011-06-30 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | PO BOX 538 BAKER, LA 70704-0538 United States Phone: 225-205-1581 | Fax: | ||||||||
Primary Practice Address | 2514 GATES CIR APT 12 BATON ROUGE, LA 70809-1017 United States Phone: 225-205-1581 | Fax: | ||||||||
Secondary Practice Address(es) | |||||||||
Health Information Exchange |
| ||||||||
Other Identifiers |
| ||||||||
Taxonomy |
|