Individual
TOMIAH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4057 N MAYFAIR RD, WAUWATOSA, WI 53222-1101
(414) 788-1084
(862) 263-7319
Mailing address
4057 N MAYFAIR RD, WAUWATOSA, WI 53222-1101
(414) 788-1084
(862) 263-7319
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
0021599
WI
Other
Enumeration date
11/05/2025
Last updated
11/05/2025
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