Individual
ELLEN KIMBERLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14122 S WABASH AVE, RIVERDALE, IL 60827-2236
(708) 841-9473
(708) 880-0172
Mailing address
14122 S WABASH AVE, RIVERDALE, IL 60827-2236
(708) 841-9473
(708) 880-0172
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
IL
Other
Enumeration date
04/14/2008
Last updated
04/14/2008
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