| Doctor Name: | CAROLE ANNE JACKSON |
| NPI Number: | 1023359361 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1200 Helen Ave N Las Vegas, NV - 890303721 |
| Business Phone Number: | 7022759838 |
| Business Fax Number: | |
| Mailing Address: | 345 Plum Horse Ave, N LAS VEGAS |
| State: | NV |
| Postal Code: | 890311317 |
| Phone Number: | 7022056717 |
| Fax Number: | |
| NPI Enumeration Date: | 03/12/2013 |
| NPI Last Update Date: | 03/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |