EBONI SHANTELLE JACKSON
Individual Provider (NPI-1)
Active
Peer Specialist
Provider Information
- NPI Number
1265229595- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 707 SHERIDAN AVE, CODY, WY, 824143409
- Phone
- (307) 578-2486
- Fax
- (307) 578-2247
Specialties & Taxonomies
Peer Specialist
Primary License: WY #190