CHARLESETTA JACKSON

MILWAUKEE, WI
NPI1922273879
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI  15371-131)
Enumeration Date2008-04-22
Last Update Date2008-04-22
Business Address
-- CHARLESETTA JACKSON SAC
4757 N 76TH ST
MILWAUKEE, WI 53218-4732
Phone number: 414-358-4171
Mailing Address
-- CHARLESETTA JACKSON SAC
4757 N 76TH ST
MILWAUKEE, WI 53218-4732
Phone number: 414-358-4171
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