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Individual

ANGELETTA MARIE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1490 E 193RD ST APT 641, EUCLID, OH 44117-1351
(216) 544-2983
Mailing address
1490 E 193RD ST APT 641, EUCLID, OH 44117-1351
(216) 544-2983

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
RK999348
OH

Other

Enumeration date
01/15/2026
Last updated
01/15/2026
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