Individual
CLISSIE TERERSA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HOME CARE
Contact information
Practice address
208 74TH ST N, BIRMINGHAM, AL 35206-4261
(313) 358-0035
(186) 665-9907
Mailing address
208 74TH ST N, BIRMINGHAM, AL 35206-4261
(313) 358-0035
(186) 665-9907
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
119405B
MO
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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