| Doctor Name: | MS. ELIZABETH A JACKSON |
| NPI Number: | 1104091784 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LIC. MASSAGE THERAPI |
| License Number: | MT3127 |
| Business Practice Address: | 94 Auburn St Ste 106 Portland, ME - 041032141 |
| Business Phone Number: | 2078783003 |
| Business Fax Number: | 2078783004 |
| Mailing Address: | 94 Auburn St, Suite 106 PORTLAND |
| State: | ME |
| Postal Code: | 041032141 |
| Phone Number: | 2078783003 |
| Fax Number: | 2078783004 |
| NPI Enumeration Date: | 04/24/2008 |
| NPI Last Update Date: | 12/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MT3127 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |