Individual
IMAN JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1425 N ST NW APT 411, WASHINGTON, DC 20005-5217
(202) 486-9552
Mailing address
2716 29TH ST SE APT 194, WASHINGTON, DC 20020-3170
(202) 486-9552
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
02/07/2024
Last updated
05/05/2025
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