Individual
KAREN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2501 CHATHAM RD STE N, SPRINGFIELD, IL 62704-4188
(630) 270-9882
Mailing address
PO BOX 1732, BOLINGBROOK, IL 60440-7400
(630) 270-9882
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
372500000X
Chore Provider
—
—
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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