Individual
THERESA LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2950 ELMWOOD AVE, KENMORE, NY 14217-1304
(716) 447-6538
Mailing address
15 BROOKHAVEN LN, LANCASTER, NY 14086-9568
(716) 908-1510
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
08/19/2019
Last updated
08/19/2019
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