Individual
MR. KEVIN R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CERTIFICATION
Contact information
Practice address
19752 SNOWDEN ST, DETROIT, MI 48235-1180
(313) 282-7040
(313) 861-4215
Mailing address
19752 SNOWDEN ST, DETROIT, MI 48235-1180
(313) 282-7040
(313) 861-4215
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
09/16/2011
Last updated
09/16/2011
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