Individual provider · NPI-1

Duane Jackson

Day Training/Habilitation Specialist · Detroit, MI

NPI number1992578058
StatusActive
Last updated in NPPESNov 1, 2023

Details

NPI
1992578058
Entity type
Individual (NPI-1)
Name
Mr. Duane Jackson
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 1, 2023
Certification date
Nov 1, 2023
Last updated
Nov 1, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
373H00000X Day Training/Habilitation Specialist––Yes

Practice location

3111 Grand River Ave
Detroit, MI 48208-2962

Phone 313-964-3900

Mailing address

29511 Steinhauer St
Inkster, MI 48141-3418

Phone 734-620-0475

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