Individual
RICKY CHARLES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
770 WOODLANE RD, WESTAMPTON, NJ 08060-3804
(609) 845-3738
Mailing address
213 W UNION ST, BURLINGTON, NJ 08016-1331
(609) 845-5098
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH0PR17MB5599
EMPLOYMENT
—
Enumeration date
05/23/2022
Last updated
05/23/2022
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