Individual
DAYVIONNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
36260 LAKE SHORE BLVD APT 201, EASTLAKE, OH 44095-1446
(440) 796-4482
Mailing address
36260 LAKE SHORE BLVD APT 201, EASTLAKE, OH 44095-1446
(440) 796-4482
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
OH
Other
Enumeration date
03/27/2023
Last updated
03/27/2023
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