Provider Demographics
NPI:1821317678
Name:JACKSON, CATHERINE DO (PHD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DO
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD STE L10
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9200
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:4455 E 56TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2995
Practice Address - Country:US
Practice Address - Phone:563-355-2577
Practice Address - Fax:563-355-4015
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist