Provider Demographics
NPI:1407160195
Name:JACKSON, SARAH BROOK
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BROOK
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 61 BOX 272-4
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-9440
Mailing Address - Country:US
Mailing Address - Phone:918-315-1115
Mailing Address - Fax:
Practice Address - Street 1:HC 61 BOX 272-4
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-9440
Practice Address - Country:US
Practice Address - Phone:918-315-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health