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Name: Derrick Logan Jackson Certificate Status: Active
Address: 11148 West 76th Terrace, #20
Shawnee, KS 66214-0000
Permit Status:
Firm/Employer: Discipline and/or Board Action: NO
Certificate Issue Date: 10/01/1990
Certificate Number: 6298
Permit Number:
Permit Issue/Renew Date: / /
Permit Expiration Date: / /