Provider Demographics
NPI:1174843031
Name:JACKSON, ROSEMARY ANN (BS)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 N ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-4124
Mailing Address - Country:US
Mailing Address - Phone:405-473-3013
Mailing Address - Fax:
Practice Address - Street 1:3005 N ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-4124
Practice Address - Country:US
Practice Address - Phone:405-473-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor