Individual
MRS. ARIEL TARNISHA NICOLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
202 W PARK AVE, CHAMPAIGN, IL 61820-3929
(217) 373-2430
Mailing address
9 HARTWELL CT APT D, SAVOY, IL 61874-9782
(217) 530-6734
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
01/04/2011
Last updated
01/04/2011
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