NPI 1003459934

Stephanie Denise Jackson

Practitioner Foster Care Agency Buckeye, AZ

Practice location

Address: 22321 W Morning Glory St, Buckeye, AZ 85326-7181
Phone: (503) 209-7572
Fax: (602) 455-4624

Registered specialties (2)

Foster Care Agency Primary

Agencies Taxonomy 253J00000X Licence 9911474 (AZ)

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Child Mental Illness Respite Care

Respite Care Facility Taxonomy 385HR2055X Licence 3311474 (AZ)

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Registry record

NPI: 1003459934
Entity type: Individual
Sex (as registered): Female
NPI issued: 23 Oct 2019
Record last updated: 10 Mar 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.