Doctor Name: | LAURA JACKMAN |
NPI Number: | 1003067307 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 180.003361 |
Business Practice Address: | 1415 Maple Rd Joliet, IL - 604321442 |
Business Phone Number: | 8157350732 |
Business Fax Number: | |
Mailing Address: | 604 Lambeth Ln, NEW LENOX |
State: | IL |
Postal Code: | 604519638 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/05/2008 |
NPI Last Update Date: | 10/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 180.003361 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |