Individual
ANTOINETTE RAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3925 N 6TH ST, MILWAUKEE, WI 53212-1139
(414) 234-7720
Mailing address
PO BOX 43, MEQUON, WI 53092-0043
(414) 234-7720
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
WI
Other
Enumeration date
10/15/2025
Last updated
10/15/2025
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