Individual
DALEDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17421 TELEGRAPH RD, DETROIT, MI 48219-3165
(313) 297-2975
Mailing address
19178 RUTHERFORD ST, DETROIT, MI 48235-2345
(313) 605-8599
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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