Individual
SUSIE BERNICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
41 COPPER RIDGE CT, DEATSVILLE, AL 36022-3242
(334) 290-8131
Mailing address
41 COPPER RIDGE CT, DEATSVILLE, AL 36022-3242
(334) 290-8131
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
3251
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3251
DEPARTMENT OF MENTAL HEALTH
AL
Enumeration date
03/06/2020
Last updated
03/06/2020
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