Janissa D Jackson in Fayetteville - Clinical Child & Adolescent
Janissa D Jackson - NPI 1043365620
Janissa D Jackson is a Clinical Child & Adolescent in Fayetteville, Arkansas. Janissa D Jackson practices all healthcare services and medical treatments related to Clinical Child & Adolescent. The NPI Number for Janissa D Jackson is 1043365620. The last update date is 2008-02-27.
Janissa D Jackson's current location address is 1 W Sunbridge Dr, Fayetteville, Arkansas. You can contact this provider via phone number 4794435575 and fax number 4794439554. The mailing address for Janissa D Jackson is 1 W Sunbridge Dr, Fayetteville, Arkansas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Janissa D Jackson |
|---|---|
| Address | 1 W Sunbridge Dr, Fayetteville, Arkansas |
| Phone Number | 4794435575 |
| Fax Number | 4794439554 |
| Sole Proprietor | Y |
| Credentials | PHD |
NPI Number Detail
| NPI Number | 1043365620 |
|---|---|
| Provider Enumeration Date | 2007-01-24 |
| Last Updated Date | 2008-02-27 |
Provider Mailing Address Detail
| Address | 1 W Sunbridge Dr |
|---|---|
| City | Fayetteville |
| State | Arkansas (AR) |
| Post Code | 727031825 |
| Phone Number | 4794435575 |
| Fax Number | 4794439554 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical Child & Adolescent |
|---|---|
| Taxonomy | 103Tc2200X |
| Licence No | 07-01P |
|
Definition: A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 5A252 | AR | BLUECROSS BLUESHIELD |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Janissa D Jackson by the Centers for Medicare & Medicaid Services?
The Janissa D Jackson has been issued the NPI (National Provider Identifier) 1043365620, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please share the complete physical address where Janissa D Jackson is geographically located?
The Janissa D Jackson is physically situated at the following location: 1 W Sunbridge Dr, Fayetteville, AR, 727031825.
What is the Janissa D Jackson's specialty and taxonomy code?
The Janissa D Jackson's specialty is Clinical Child & Adolescent, and the corresponding taxonomy code is 103Tc2200X.
On what date was the 1043365620 assigned to Janissa D Jackson?
The Janissa D Jackson was issued its 1043365620 on 2007-01-24, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
When was the information regarding Janissa D Jackson most recently updated?
The details pertaining to the Janissa D Jackson, including its address, specialty, and other relevant information, were last refreshed on 2008-02-27.
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