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Theresa Jackson
NPI 1104207083 · on the registry since 2015
Practice
- Address
- 77 E Great Lakes St Apt 303
River Rouge, MI 48218 - Phone
- (313) 208-4140
Registry record
- Primary taxonomy
- Chore Provider
372500000X
- Licence states on file
- MI
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2015-06-16
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan