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1962508192
CLARK KENT JACKSON
YAKIMA, WA
NPI
1962508192
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: WA LW6908)
Enumeration Date
2006-09-15
Last Update Date
2007-07-08
Business Address
Mr. CLARK KENT JACKSON MSW
6 S 2ND ST STE 918
YAKIMA, WA 98901-2632
Phone number: 509-961-8233
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Mailing Address
Mr. CLARK KENT JACKSON MSW
2004 E 1ST AVE
ELLENSBURG, WA 98926-9021
Phone number: 509-933-4803
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