| NPI | 1992188239 |
|---|---|
| Former Name | AMY J JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801103335) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802088547) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801103335) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2018-11-08 |