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Individual

JAQUALA BURKS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3121 N 86TH ST, MILWAUKEE, WI 53222-3710
(414) 544-9785
Mailing address
3121 N 86TH ST, MILWAUKEE, WI 53222-3710
(414) 544-9785

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
352250
LICENSE NUMBER
WI
Enumeration date
09/16/2021
Last updated
02/13/2022
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