Individual
JEWELLE RUTH JACKLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
11860 ZEA ST NW APT 306, COON RAPIDS, MN 55433-6838
(763) 218-5332
Mailing address
11860 ZEA ST NW APT 306, COON RAPIDS, MN 55433-6838
(763) 218-5332
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3542
MN
Other
Enumeration date
06/10/2024
Last updated
06/10/2024
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