Individual
ETHEL M JACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
751 BAYOU PINES EAST DR STE C, LAKE CHARLES, LA 70601-7196
(337) 433-3292
(337) 433-3293
Mailing address
751 BAYOU PINES EAST DR STE C, LAKE CHARLES, LA 70601-7196
(337) 433-3292
(337) 433-3293
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/02/2019
Last updated
10/02/2019
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