Individual
AMBER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 W TOKAY ST, LODI, CA 95240-3965
(925) 917-4380
Mailing address
1111 W TOKAY ST, LODI, CA 95240-3965
(925) 917-4380
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
07/16/2026
Last updated
07/16/2026
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