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Individual

MISS SONNI LEE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
151 E CLUBHOUSE DR, NEW CASTLE, CO 81647-9424
(970) 618-7537
Mailing address
171 UTE WAY, SILT, CO 81652-9580
(970) 618-7537

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0011121
CO

Other

Enumeration date
11/13/2018
Last updated
11/13/2018
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