Individual
MS. JACKIE ELAINE CLOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13231 BUTTERNUT RD, BURTON, OH 44021-9567
(440) 834-1089
Mailing address
10005 KNOWLTON RD, GARRETTSVILLE, OH 44231-9793
(330) 322-1965
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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