Individual
MRS. WAUKESHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1222 S GRANT AVE, INDIANAPOLIS, IN 46203-2338
(317) 746-3301
Mailing address
1222 S GRANT AVE, INDIANAPOLIS, IN 46203-2338
(317) 746-3301
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
06/08/2022
Last updated
06/15/2022
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