Individual
GLENISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4700 WISHERS DRIVE, MARRERO, LA 70072
(504) 407-0709
(504) 333-6252
Mailing address
1406 ESPLANADE AVE, NEW ORLEANS, LA 70116-1803
(504) 304-4097
(504) 218-7962
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251S00000
—
LA
Enumeration date
11/20/2015
Last updated
11/20/2015
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