Individual
JUSTICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9115 S CICERO AVE STE 200, OAK LAWN, IL 60453-1771
(773) 449-0859
(708) 398-8155
Mailing address
5113 S HARPER AVE STE 2C, CHICAGO, IL 60615-4119
(773) 449-0859
(708) 398-8155
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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