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Mary Jackson
NPI 1275144149 · on the registry since 2020
Practice
- Address
- 4559 Benes Ave
Glen Carbon, IL 62034 - Phone
- (217) 525-8332
- Clinicians at this address
- 51
Additional practice sites
- 6 Eagle Ctr Ste 1, O Fallon, IL
- 400 Saint Louis St Ste 1, Edwardsville, IL
Registry record
- Primary taxonomy
- 103K00000X
103K00000X
- Also registered as
- 106E00000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2023-07-03
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois