Provider Demographics
NPI:1184250375
Name:JACKS, MALLORY (CD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:JACKS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 SPYGLASS DR APT 173
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7586
Mailing Address - Country:US
Mailing Address - Phone:501-658-7888
Mailing Address - Fax:
Practice Address - Street 1:1302 SPYGLASS DR APT 173
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7586
Practice Address - Country:US
Practice Address - Phone:501-658-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula