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Phyllis Jackson, LISW
NPI 1891133898 · on the registry since 2013
Practice
- Address
- 12647 Olive Blvd
Suite 600
Saint Louis, MO 63141 - Phone
- (800) 325-3982
- Fax
- (877) 685-9880
- Organisation at this address
- Connecticut Dental Professionals, P.C.
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 104
Registry record
- Primary taxonomy
- 104100000X
104100000X
- Licence states on file
- NM
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2013-06-12
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 Missouri