NPI Registry.org

Shantell Jackson

NPI Registration Record

Provider / OrganizationNPIDate Certified
SHANTELL JACKSON19923078702020-11-15
Entity TypeIndividual
Provider Name Shantell Jackson
Practice Office Address1834 ROBINDALE ST
WICKLIFFE, OH US
Practice Office Telephone3303682617
Mailing Address1834 ROBINDALE ST
WICKLIFFE, OH 440921843 US
Business Telephone3303682617
HPT Codes
CodeLicense NoState
103TM1800X PRIMARY4303862 OH
OPI Codes

© 2020 NPIRegistry.org | Contact | Privacy Policy
45 CFR Part 162