Individual
DANNISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHS
Contact information
Practice address
404 HEARNE AVE, SHREVEPORT, LA 71103
(318) 716-1369
(318) 675-0120
Mailing address
404 HEARNE AVE, SHREVEPORT, LA 71103-2022
(318) 716-1369
(318) 675-0120
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/01/2015
Last updated
08/01/2018
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