Individual
SHAUNA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
720 LAKEWOOD ST, DETROIT, MI 48215-2945
(313) 656-8238
Mailing address
720 LAKEWOOD ST, DETROIT, MI 48215-2945
(313) 656-8238
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
08/14/2015
Last updated
08/14/2015
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