| NPI | 1528224219 |
|---|---|
| Former Name | MELISSA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME109621) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125051513) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A108358) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME 109621) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2021-01-17 |