Individual
GENNELL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3422 BASSETT RD APT 1, CINCINNATI, OH 45205-2203
(513) 543-5117
Mailing address
3422 BASSETT RD APT 1, CINCINNATI, OH 45205-2203
(513) 543-5117
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
03/31/2023
Last updated
03/31/2023
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