Individual
TIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2510 COMMONS BLVD STE 130, BEAVERCREEK, OH 45431-3820
(937) 558-3064
Mailing address
2510 COMMONS BLVD STE 130, BEAVERCREEK, OH 45431-3820
(937) 558-3064
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD.8212
OH
Other
Enumeration date
05/31/2019
Last updated
05/31/2019
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