| NPI | 1033633672 |
|---|---|
| Former Name | SIMONE YVONNE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2023-01-05 |