Individual
KAITLYN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3950 HOLLYWOOD RD, SUITE 140, SAINT JOSEPH, MI 49085-9159
(260) 556-7150
Mailing address
3950 HOLLYWOOD RD, SUITE 140, SAINT JOSEPH, MI 49085-9159
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001465
MI
Other
Enumeration date
06/15/2016
Last updated
06/15/2016
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