Individual
ROSE LOUISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3450 INDIANA AVE, SAINT LOUIS, MO 63118-3233
(314) 249-9765
(314) 771-5063
Mailing address
3450 INDIANA AVE, SAINT LOUIS, MO 63118-3233
(314) 249-9765
(314) 771-5063
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
CC0657115
MO
Other
Enumeration date
12/31/2007
Last updated
01/09/2008
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