Individual
CHAD WALKER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7709 RIVERVIEW DR APT 104, JENISON, MI 49428-7960
(616) 889-6781
Mailing address
7709 RIVERVIEW DR APT 104, JENISON, MI 49428-7960
(616) 889-6781
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89619284
—
MI
Enumeration date
04/22/2019
Last updated
06/11/2019
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