Provider Demographics
NPI:1710410386
Name:JACKSON, HAYLEY (LAC)
Entity Type:Individual
Prefix:MS
First Name:HAYLEY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LOMBARD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-1139
Mailing Address - Country:US
Mailing Address - Phone:415-421-1115
Mailing Address - Fax:415-421-1116
Practice Address - Street 1:150 LOMBARD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-1139
Practice Address - Country:US
Practice Address - Phone:415-421-1115
Practice Address - Fax:415-421-1116
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16580171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist