Individual
KATHARINE MAEVE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5500 ARMSTRONG RD, BATTLE CREEK, MI 49037-7314
(269) 966-5600
Mailing address
11132 PLEASANT LAKE RD, DELTON, MI 49046-9560
(269) 366-6661
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
09162020
MI
390200000X
Student in an Organized Health Care Education/Training Program
26439446
MI
Other
Enumeration date
08/12/2021
Last updated
08/12/2021
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