Individual
MICHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9761 RAVINIA LN APT 1S, ORLAND PARK, IL 60462-6571
(219) 252-7938
Mailing address
9761 RAVINIA LN APT 1S, ORLAND PARK, IL 60462-6571
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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