| NPI | 1245701127 |
|---|---|
| Former Name | MELISSA ANN JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5468) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 5468) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2019-01-23 |