Individual
SHANNON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REHAB TECH
Contact information
Practice address
1950 RIDGEDALE RD, SOUTH BEND, IN 46614-2243
(574) 291-6722
Mailing address
507 E BROADWAY ST, SOUTH BEND, IN 46601-3503
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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