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General NPI Number Information
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NPI Number | 1215973425
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Entity Type | Individual
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Provider Name | DAWN JACKSON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 9900 W SAMPLE RD STE 300
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4077
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Country | US
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Telephone | 954-320-7881
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Fax |
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Provider Business Mailing Address
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Address Line | 9900 W SAMPLE RD STE 300
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4077
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Country | US
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Telephone | 954-320-7881
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 015925-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8115
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License Number State | FL
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