Organization
1VISION OUTREACH RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMIKA L JACKSON (DIRECTOR/OWNER)
(414) 899-7753
Entity
Organization
Contact information
Practice address
4123 N 44TH ST, MILWAUKEE, WI 53216-1503
(414) 899-7753
Mailing address
4123 N 44TH ST, MILWAUKEE, WI 53216-1503
(414) 899-7753
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EISZUSP50K
—
WI
Enumeration date
09/22/2016
Last updated
09/22/2016
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