Individual
ANEITREAH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1434 HAWN AVE STE 12, SHREVEPORT, LA 71107-6508
(318) 675-0224
Mailing address
1434 HAWN AVE STE 12, SHREVEPORT, LA 71107-6508
(318) 675-0224
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/16/2021
Last updated
08/16/2021
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