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Individual

LONZETTA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CPRS

Contact information

Practice address
76 W JIMMIE LEEDS RD STE 402, GALLOWAY, NJ 08205-9400
(609) 573-5260
(609) 573-5261
Mailing address
700 W PARK AVE, PLEASANTVILLE, NJ 08232-4360
(609) 334-4574

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CPRS-50120
NJ

Other

Enumeration date
08/25/2021
Last updated
08/25/2021
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