Individual
MS. LIYAH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1607 W 12TH ST, DAVENPORT, IA 52804-4086
(331) 662-8951
Mailing address
420 W RIVER DR, DAVENPORT, IA 52801-1150
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
04/23/2020
Last updated
04/23/2020
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