Individual
AUTUMN MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
549 E FRONT ST, LOGAN, OH 43138-1717
(740) 407-8697
Mailing address
549 E FRONT ST, LOGAN, OH 43138-1717
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
APS.003224
OH
Other
Enumeration date
06/22/2022
Last updated
06/22/2022
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