Individual
MS. LAKESHIA MICHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2205 BLUE BELL TER, KEARNEY, MO 64060-7313
(816) 588-1343
Mailing address
2205 BLUE BELL TER, KEARNEY, MO 64060-7313
(816) 903-0103
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
MO
171M00000X
Case Manager/Care Coordinator
—
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
MO
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
MO
Other
Enumeration date
05/21/2012
Last updated
05/21/2012
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