Individual
ELISHIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
417 W. YELM AVE., YELM, WA 98597
(360) 458-2444
Mailing address
417 W YELM AVE, YELM, WA 98597
(360) 458-2444
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A160668335
WA
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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