Provider Demographics
NPI:1366718686
Name:WILSON, JACKLYN MARIE (HHA)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 JASPER PL SE APT 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2948
Mailing Address - Country:US
Mailing Address - Phone:202-271-6137
Mailing Address - Fax:
Practice Address - Street 1:1352 JASPER PL SE APT 103
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2948
Practice Address - Country:US
Practice Address - Phone:202-271-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide