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Individual

TIESHA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1393 CONGRESS ST SE APT 3, WASHINGTON, DC 20032-5076
(202) 423-0041
Mailing address
76 FORRESTER ST SW APT 201, WASHINGTON, DC 20032-2142
(202) 779-5972

Taxonomy

Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary

Other

Enumeration date
11/15/2021
Last updated
11/15/2021
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