C Wesley Jackson Jr Phd INC
Psychologist, Clinical in Cleveland Heights, OH. Organization (NPI-2).
NPI number1720202500
StatusActive
Last updated in NPPESJul 30, 2012
Details
- NPI
- 1720202500
- Entity type
- Organization (NPI-2)
- Legal business name
- C Wesley Jackson Jr Phd INC
- Organization subpart
- No
- Enumeration date
- Apr 12, 2007
- Last updated
- Jul 30, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | 474 | OH | Yes |
| 103TC0700X | Psychologist, Clinical | 000519 | MI |
Practice location
2980 Washington BlvdCleveland Heights, OH 44118-2450
Phone 216-321-9355 · Fax 216-932-3341
Mailing address
2980 Washington BlvdCleveland Heights, OH 44118-2450
Phone 216-321-9355 · Fax 216-932-3341
Authorized official
C Wesley Jackson
President Owner
2163219355
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