Provider Demographics
NPI:1972247179
Name:JACKSON, BAYLEE LYN
Entity type:Individual
Prefix:
First Name:BAYLEE
Middle Name:LYN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
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 1003
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:WY
Mailing Address - Zip Code:82939-1003
Mailing Address - Country:US
Mailing Address - Phone:307-747-7586
Mailing Address - Fax:
Practice Address - Street 1:849 FRONT ST STE 103
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3475
Practice Address - Country:US
Practice Address - Phone:307-444-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker