Individual
MONIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21630 JESSEL AVE, DETROIT, MI 48219
(855) 213-9980
Mailing address
5460 WOODLAND RIDGE DR, FLINT, MI 48532-2271
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
5202005667
MI
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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