Individual
MS. TIFFANY RENEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.ED.
Contact information
Practice address
5533 LITCHFIELD ST, PHILADELPHIA, PA 19143-4714
(267) 320-8598
Mailing address
5533 LITCHFIELD ST, PHILADELPHIA, PA 19143-4714
(267) 320-8598
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
171W00000X
PA
Other
Enumeration date
02/25/2010
Last updated
02/25/2010
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