Individual
AMANDA RENEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
GENERAL DELIVERY, ANTIOCH, IL 60002-9999
(262) 269-4996
Mailing address
317 PARK AVE, UNIT 1, ANTIOCH, IL 60002-1516
(262) 269-4996
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
12/17/2015
Last updated
12/17/2015
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