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General NPI Number Information
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NPI Number | 1376261602
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Entity Type | Individual
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Provider Name | CASSIE THACKER JACKSON MASTER OF EDUCATION
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Gender | Female
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1423 PEGER RD
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City | FAIRBANKS
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State | AK
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Zip | 99709-5169
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Country | US
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Telephone | 907-371-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 FOLKER ST
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City | ANCHORAGE
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State | AK
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Zip | 99508-5321
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Country | US
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Telephone | 907-563-1000
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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