Provider Demographics
NPI:1801027883
Name:JACKSON, MICHELLE (MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 PRESSLER ST
Mailing Address - Street 2:CPB 5.3450 UNIT 1354
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3721
Mailing Address - Country:US
Mailing Address - Phone:713-792-6691
Mailing Address - Fax:713-563-0909
Practice Address - Street 1:1155 PRESSLER ST
Practice Address - Street 2:CPB 5.3450 UNIT 1354
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3721
Practice Address - Country:US
Practice Address - Phone:713-792-6691
Practice Address - Fax:713-563-0909
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS