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General NPI Number Information
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NPI Number | 1003789710
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Entity Type | Individual
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Provider Name | TONIE JONEE JACKSON
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Gender | Female
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 10046 N METRO PKWY W
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City | PHOENIX
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State | AZ
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Zip | 85051-1437
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Country | US
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Telephone | 844-646-3247
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Fax |
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Provider Business Mailing Address
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Address Line | 5713 W WILLOW RIDGE DR
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City | LAVEEN
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State | AZ
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Zip | 85339-3139
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Country | US
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Telephone | 184-464-6324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22397
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License Number State | AZ
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