Individual
JACKIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1019 N RANGE AVE, SUITE B, DENHAM SPRINGS, LA 70726-2407
(225) 791-8154
(225) 791-8152
Mailing address
1019 N RANGE AVE, SUITE B, DENHAM SPRINGS, LA 70726-2407
(225) 791-8154
(225) 791-8152
Taxonomy
Speciality
Code
Description
License number
State
173C00000X
Reflexologist
1169
LA
225700000X
Massage Therapist
Primary
1169
LA
Other
Enumeration date
11/04/2011
Last updated
11/04/2011
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