Individual
DEJONERIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2156 WOODDALE BLVD, BATON ROUGE, LA 70806-1403
(225) 930-8058
(225) 930-8059
Mailing address
2156 WOODDALE BLVD, BATON ROUGE, LA 70806-1403
(225) 930-8058
(225) 930-8059
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790236586
—
LA
Enumeration date
07/23/2019
Last updated
07/23/2019
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