Thomas Wallace Jackson

NPI #1205588670 in Canton, Ohio

Provider Information

NPI Number: 1205588670
Entity Type: Individual
Name: Thomas Wallace Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Case Manager/Care Coordinator
Enumeration Date: Jan 26, 2022
Last Updated: Jan 26, 2022

Practice Location

Address: 400 TUSCARAWAS ST W
City: Canton
State: Ohio
ZIP Code: 44702-2044
Phone: (330) 612-1739

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Manager/Care Coordinator	171M00000X	Primary

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