Individual
RANDI MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(313) 588-6932
Mailing address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(313) 588-6932
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
2930
MI
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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