Individual
MS. JACQUELINE MICHELE SHARP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMT
Contact information
Practice address
2204 ARTHUR AVE, ROCKFORD, IL 61101-5224
(815) 243-9366
Mailing address
2204 ARTHUR AVE, ROCKFORD, IL 61101-5224
(815) 243-9366
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
227003425
IL
Other
Enumeration date
10/19/2009
Last updated
10/19/2009
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