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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