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NPI Code Detail

MEDICARE: MS. KRISTIN JACKSON EDS

MEDICARE: MS. KRISTIN JACKSON EDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1215876735
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTIN JACKSON EDS
Provider Business Mailing Address
First Line : 15802 N PARKVIEW PL
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-7466
Country : US
Telephone Number : 623-876-7400
Fax Number :
Provider Business Practice Location Address
First Line : 15802 N PARKVIEW PL
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-7466
Country : US
Telephone Number : 623-876-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2026
Last Update Date : 03/27/2026

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