Individual
TIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
323 S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 746-0410
Mailing address
323 S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 746-0410
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1559-39
WI
Other
Enumeration date
08/17/2016
Last updated
02/19/2019
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