Individual
ALISA MAE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1848 WILLOW PASS RD STE 207, CONCORD, CA 94520-2542
(510) 637-8188
Mailing address
24085 AMADOR ST FL 4, HAYWARD, CA 94544-1226
(510) 670-8483
(510) 670-6444
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
CA
225400000X
Rehabilitation Practitioner
Primary
—
CA
Other
Enumeration date
04/20/2022
Last updated
05/13/2025
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