Spencer Jackson

NPI #1164185484 in Pryor, Oklahoma

Provider Information

NPI Number: 1164185484
Entity Type: Individual
Name: Spencer Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: Oct 14, 2021
Last Updated: Oct 14, 2021

Practice Location

Address: 109 N FAIRLAND ST
City: Pryor
State: Oklahoma
ZIP Code: 74361-4205
Phone: (918) 825-1405

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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