Stacy Latrice Jackson
NPI #1982898227 in Seattle, Washington
Provider Information
- NPI Number
- 1982898227
- Entity Type
- Individual
- Name
- Stacy Latrice Jackson
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Specialist
- Enumeration Date
- Aug 29, 2007
- Last Updated
- Dec 18, 2008
Practice Location
- Address
- 6817 GREENWOOD AVE. N.
- City
- Seattle
- State
- Washington
- ZIP Code
- 98103-8801
- Phone
- (725) 351-0871
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist |
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