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Individual

ANNIE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
517 E 153RD ST, PHOENIX, IL 60426-2308
(708) 513-2866
Mailing address
517 E 153RD ST, PHOENIX, IL 60426-2308
(708) 513-2866

Taxonomy

Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
043068868
IL

Other

Enumeration date
10/26/2016
Last updated
10/26/2016
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