Individual
JACQUELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
331 MILAM ST, SHREVEPORT, LA 71101
(318) 213-0904
Mailing address
9730 BAIRD RD APT 2310, SHREVEPORT, LA 71118-3879
(318) 560-2311
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/23/2016
Last updated
11/20/2018
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