Individual
MISS TAMIKA ELISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
626 E WOODLAND PARK AVE, APT 307, CHICAGO, IL 60616-4155
(312) 731-6060
Mailing address
626 E WOODLAND PARK AVE, APT 307, CHICAGO, IL 60616-4155
(312) 731-6060
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/14/2008
Last updated
05/14/2008
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