Individual
LAURA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3256 W 25TH ST, CLEVELAND, OH 44109-1637
(216) 632-2714
Mailing address
3256 W 25TH ST, CLEVELAND, OH 44109-1637
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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