MS. Keely Jackson, CERTIFIED

NPI #1396044269 in Macomb, Michigan

Provider Information

NPI Number: 1396044269
Entity Type: Individual
Name: MS. Keely Jackson, CERTIFIED
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: CERTIFIED
Enumeration Date: Mar 17, 2011
Last Updated: Mar 17, 2011

Practice Location

Address: 21268 VENICE DR
City: Macomb
State: Michigan
ZIP Code: 48044-1315
Phone: (586) 948-8954

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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