MRS. Kim Marie Jackson

NPI #1285933176 in Wagoner, Oklahoma

Provider Information

NPI Number: 1285933176
Entity Type: Individual
Name: MRS. Kim Marie Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor
Enumeration Date: Mar 18, 2011
Last Updated: Mar 18, 2011

Practice Location

Address: 2109 S HIGHWAY 69
City: Wagoner
State: Oklahoma
ZIP Code: 74467-9310
Phone: (918) 485-0242

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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