Individual
MR. GLENN ALLEN JACKSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6736 S PEORIA AVE APT 221, TULSA, OK 74136-3649
(918) 402-9235
Mailing address
6736 S PEORIA AVE APT 221, TULSA, OK 74136-3649
(918) 402-9235
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/19/2010
Last updated
05/19/2010
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