Individual
KIQIANA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8808 S HERMITAGE AVE, CHICAGO, IL 60620-4940
(773) 656-8638
Mailing address
8808 S HERMITAGE AVE, CHICAGO, IL 60620-4940
(773) 656-8638
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/28/2015
Last updated
12/01/2015
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