Individual
AISHA DELANE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20147 MONTE VISTA ST, DETROIT, MI 48221-1053
(248) 798-7856
Mailing address
22555 PONTCHARTRAIN DR, SOUTHFIELD, MI 48034-6204
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
10/29/2025
Last updated
10/29/2025
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