Individual
MELODIE ISMA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 S 4TH ST, PHILADELPHIA, PA 19147-5948
(215) 339-1070
(215) 339-1080
Mailing address
432 N 6TH ST, PHILADELPHIA, PA 19123-4004
(215) 925-2400
(215) 925-9162
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/18/2011
Last updated
05/18/2011
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