Individual
MR. DEION A JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2204 ST. CHARLES ST, LECOMPTE, LA 71346
(318) 406-3044
(318) 406-3045
Mailing address
2204 ST. CHARLES ST, LECOMPTE, LA 71346
(318) 406-3044
(318) 406-3045
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/14/2017
Last updated
05/17/2018
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