Individual
JACKSON CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1045 KLOTZ RD, BOWLING GREEN, OH 43402-4820
(419) 352-7588
Mailing address
1045 KLOTZ RD, BOWLING GREEN, OH 43402-4820
(330) 495-2777
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
11/16/2023
Last updated
11/16/2023
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