Individual
BRIAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1125 N DELANY RD, GURNEE, IL 60031-2007
(800) 974-4378
(630) 515-1536
Mailing address
24014 W RENWICK RD STE F, PLAINFIELD, IL 60544-8708
(800) 974-4378
(630) 515-1536
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056010871
IL
Other
Enumeration date
01/09/2015
Last updated
10/05/2022
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