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1427020957
WALLACE J JACKMON
SIOUX FALLS, SD
NPI
1427020957
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: SD 477)
Enumeration Date
2006-02-07
Last Update Date
2018-10-11
Business Address
WALLACE J JACKMON PhD
4400 W 69TH ST STE 1500
SIOUX FALLS, SD 57108-8170
Phone number: 605-322-5700
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Mailing Address
WALLACE J JACKMON PhD
PO BOX 86370
SIOUX FALLS, SD 57118-6370
Phone number: 605-322-7510
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