Individual
DANIELLE N JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3366 W 130TH ST, CLEVELAND, OH 44111-2614
(216) 203-1668
Mailing address
3366 W 130TH ST, CLEVELAND, OH 44111-2614
(216) 203-1668
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
OH
251X00000X
Supports Brokerage Agency
—
OH
253Z00000X
In Home Supportive Care Agency
—
OH
3747P1801X
Personal Care Attendant
—
OH
376J00000X
Homemaker
Primary
—
OH
Other
Enumeration date
08/30/2023
Last updated
08/30/2023
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