Individual
SHANTELL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1834 ROBINDALE ST, WICKLIFFE, OH 44092-1843
(330) 368-2617
Mailing address
1834 ROBINDALE ST, WICKLIFFE, OH 44092-1843
(330) 368-2617
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
4303862
OH
Other
Enumeration date
11/15/2020
Last updated
11/15/2020
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