Organization
JACKSON LAB SERVICES LLC
Active
Organization
JACKSON LAB SERVICES LLC
Active
Other names
Jackson Lab services LLC
Organization subpart
No
Provider details
NPI number
Authorized official
GEMONTASIA JACKSON (DIRECTOR)
(414) 939-5802
Entity
Organization
Contact information
Practice address
2872 N 59TH ST, MILWAUKEE, WI 53210-1504
(414) 939-5802
Mailing address
5721 N 90TH ST, MILWAUKEE, WI 53225-2833
(414) 939-5802
(414) 381-2327
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
12/18/2023
Last updated
07/18/2025
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