Provider Demographics
NPI:1699105007
Name:JACKSON, JENNIFER (RDS, CIT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RDS, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 ARMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904-4317
Mailing Address - Country:US
Mailing Address - Phone:479-783-8849
Mailing Address - Fax:479-783-1914
Practice Address - Street 1:3900 ARMOUR AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-4317
Practice Address - Country:US
Practice Address - Phone:479-783-8849
Practice Address - Fax:479-783-1914
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor