Provider Demographics
NPI:1992914709
Name:CLASON, JACKIE
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:CLASON
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 1:44 CROWN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-7903
Mailing Address - Country:US
Mailing Address - Phone:508-693-7091
Mailing Address - Fax:
Practice Address - Street 1:44 CROWN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-7903
Practice Address - Country:US
Practice Address - Phone:508-693-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath