Individual
JACQUELINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10239 PRINCE DR, SAINT LOUIS, MO 63136-5932
(314) 401-7049
Mailing address
10239 PRINCE DR, SAINT LOUIS, MO 63136-5932
(314) 401-7049
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
MO
Other
Enumeration date
04/10/2014
Last updated
04/10/2014
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