Jackson, Janissa D

Jackson, Janissa D is an sole proprietor health care provider with primary practice located at 1 W Sunbridge Dr , Fayetteville AR 72703-1825. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Clinical Child & Adolescent is her primary health care specialty. Jackson, Janissa D can be contacted via phone (479) 443-5575.

Contact Information

Primary practice address
1 W Sunbridge Dr Fayetteville AR 72703-1825
Phone: (479) 443-5575
Fax: (479) 443-9554
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 07-01P Arkansas
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 07-01P Arkansas

Profile Details

NPI number 1043365620
LBN Legal business name Jackson, Janissa D
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 24th, 2007
Last updated Feb 27th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043365620 NPPES
Arkansas Other 5A252 BLUECROSS BLUESHIELD

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