Most Relevant Information
Provider Data
| NPI Number: | 1003509902 |
| Provider Name: | TARA MONIQUE JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/29/2023 |
| Last Updated: | 05/29/2023 |
Provider Practice Location
920 BELLEVUE ST SE
WASHINGTON
DC
200326030
Practice Location Phone/Fax
| Phone: | 2025624939 |
| Fax: |
Provider Mailing Location
920 BELLEVUE ST SE
WASHINGTON
DC
200326030
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |