Shantell Jackson

NPI #1992307870 in Wickliffe, Ohio

Provider Information

NPI Number: 1992307870
Entity Type: Individual
Name: Shantell Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist - Intellectual & Developmental Disabilities
Enumeration Date: Nov 15, 2020
Last Updated: Nov 15, 2020

Practice Location

Address: 1834 ROBINDALE ST
City: Wickliffe
State: Ohio
ZIP Code: 44092-1843
Phone: (330) 368-2617

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Intellectual & Developmental Disabilities — Intellectual & Developmental Disabilities	103TM1800X	Primary

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