Provider Demographics
NPI:1588936579
Name:JACKSON, JULIA (MS)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 C ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5153
Mailing Address - Country:US
Mailing Address - Phone:907-279-9634
Mailing Address - Fax:907-279-0148
Practice Address - Street 1:8012 STEWART MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9013
Practice Address - Country:US
Practice Address - Phone:907-279-9634
Practice Address - Fax:907-279-0148
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health