Individual
DEJA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
823 ELSWORTH PL, SAINT LOUIS, MO 63135-3127
(314) 372-5626
(314) 222-3858
Mailing address
823 ELSWORTH PL, SAINT LOUIS, MO 63135-3127
(314) 372-5626
(314) 222-3858
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02
—
MO
Enumeration date
11/24/2021
Last updated
11/24/2021
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