Individual
KENISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1418 MARION BARRY AVE SE, WASHINGTON, DC 20020-5615
(202) 890-9972
Mailing address
523 G ST SW APT 203, WASHINGTON, DC 20024-2744
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/29/2023
Last updated
01/30/2025
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