Provider Demographics
NPI:1285277897
Name:JACKSON, ANAHEED (ND)
Entity type:Individual
Prefix:DR
First Name:ANAHEED
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-0340
Mailing Address - Country:US
Mailing Address - Phone:303-815-7346
Mailing Address - Fax:
Practice Address - Street 1:21011 NE CEDAR CREEK RD
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:WA
Practice Address - Zip Code:98601-3842
Practice Address - Country:US
Practice Address - Phone:303-815-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4281175F00000X
WA61009784175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath