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Individual

JACKIE TILLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1814 N MORRISON BLVD, HAMMOND, LA 70401-1551
(985) 419-2430
(985) 419-2431
Mailing address
1814 N MORRISON BLVD, HAMMOND, LA 70401-1551

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1538386875
LA
Enumeration date
03/09/2021
Last updated
03/09/2021
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