Individual
CHARRISE KATRINA JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4235 N 52ND ST, MILWAUKEE, WI 53216-1337
(414) 617-5299
Mailing address
4235 N 52ND ST, MILWAUKEE, WI 53216-1337
(414) 617-5299
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/04/2023
Last updated
09/04/2023
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