Individual
MRS. TERESA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
306 W VLIET ST # 102, MILWAUKEE, WI 53212-4014
(414) 416-5749
Mailing address
306 W VLIET ST # 102, MILWAUKEE, WI 53212-4014
(414) 416-5749
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
WI
Other
Enumeration date
03/02/2022
Last updated
11/01/2022
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