| NPI | 1871762476 |
|---|---|
| Doing Business As | JANISSA D JACKSON PHD |
| Entity Type | Organization |
| Authorized Contact | LAVONNA LATTA Business Manager 479-443-5575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AR 07-01P) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AR 07-01P) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2008-02-27 |