Individual
MARISA ZOE-TATIANA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
912 S WOOD ST, M/C 913, CHICAGO, IL 60612-4300
(312) 996-3583
Mailing address
912 S WOOD ST, M/C 913, CHICAGO, IL 60612-4300
(312) 996-3583
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/10/2015
Last updated
05/24/2016
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