Individual
MRS. HOLLI CHEREE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LMT, CES, PES
Contact information
Practice address
5109 BLUESTEM WAY, CALDWELL, ID 83607-5557
(208) 964-9504
Mailing address
5109 BLUESTEM WAY, CALDWELL, ID 83607-5557
(208) 964-9504
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
225700000X
Massage Therapist
Primary
MAS-3601
ID
Other
Enumeration date
08/02/2017
Last updated
03/29/2023
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