Jerome Alexander-Terrell Jackson
Jerome Alexander-Terrell Jackson is a Child Mental Illness Respite Care in Peoria, Arizona. Practices as a sole proprietor. Licensed in Arizona.
- Licensed in
- AZ
- In the registry since
- 2020
- Specialties on file
- 2
Practice location Address checks out
9680 W Northern Ave Unit 2311Peoria, AZ 85345-4655
Phone: (989) 980-8286
Fax: (602) 455-4626
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Foster Care Agency (primary) | Taxonomy 253J00000X · Licence 10195508 (AZ) |
|---|---|
| Child Mental Illness Respite Care | Taxonomy 385HR2055X · Licence 10195508 (AZ) |
Record details
| NPI number | 1740815497 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | March 3, 2020 |
| Last updated in NPPES | March 3, 2020 |
| Certification date | March 3, 2020 |
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