Individual
JANISA LEANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 E ACADEMY AVE, SECOND LEVEL SUITES, JENNINGS, LA 70546-5331
(337) 824-1255
(337) 824-1257
Mailing address
2525 YOUREE DR, SHREVEPORT, LA 71104-3671
(318) 742-3408
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/15/2016
Last updated
11/15/2016
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