Individual
TIFFANY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 S EDWIN C MOSES BLVD, DAYTON, OH 45417-3424
(937) 734-8333
Mailing address
PO BOX 932944, CLEVELAND, OH 44193-0027
(937) 734-4310
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
APS.005097
OH
Other
Enumeration date
11/24/2025
Last updated
11/24/2025
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