Individual
JESSICA GLENN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
5635 W FORT ST, DETROIT, MI 48209-3154
(313) 849-3920
Mailing address
5635 W FORT ST, DETROIT, MI 48209-3154
(313) 849-3920
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
4704267739
MI
367A00000X
Advanced Practice Midwife
Primary
4704267739
MI
Other
Enumeration date
12/18/2012
Last updated
04/15/2025
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