Individual
MS. KEELY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERTIFIED
Contact information
Practice address
21268 VENICE DR, MACOMB, MI 48044-1315
(586) 948-8954
(586) 948-8954
Mailing address
21268 VENICE DR, MACOMB, MI 48044-1315
(586) 948-8954
(586) 948-8954
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
911223
CO
Other
Enumeration date
03/17/2011
Last updated
03/17/2011
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