Individual
CHANEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
93 W GLENDALE ST, BEDFORD, OH 44146-3273
(216) 855-2969
Mailing address
93 W GLENDALE ST, BEDFORD, OH 44146-3273
(216) 855-2969
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
400702651207
OH
376K00000X
Nurse's Aide
400702651207
OH
Other
Enumeration date
12/11/2016
Last updated
12/11/2016
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