NPI 1740815497

Jerome Alexander-Terrell Jackson

Practitioner Foster Care Agency Peoria, AZ

Practice location

Address: 9680 W Northern Ave Unit 2311, Peoria, AZ 85345-4655
Phone: (989) 980-8286
Fax: (602) 455-4626

Registered specialties (2)

Foster Care Agency Primary

Agencies Taxonomy 253J00000X Licence 10195508 (AZ)

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Child Mental Illness Respite Care

Respite Care Facility Taxonomy 385HR2055X Licence 10195508 (AZ)

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Registry record

NPI: 1740815497
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Mar 2020
Record last updated: 3 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.