Individual
BETHANY MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
175 FRANKS AVE, WADSWORTH, OH 44281-1607
(330) 814-2101
Mailing address
175 FRANKS AVE, WADSWORTH, OH 44281-1607
(330) 814-2101
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
SV455422
OH
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
07/05/2024
Last updated
07/05/2024
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