Individual
SAMANTHA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1400 BELLINGER ST, EAU CLAIRE, WI 54703-5222
(715) 838-5222
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(715) 838-5222
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3178-29
WI
Other
Enumeration date
09/29/2021
Last updated
10/21/2021
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