Provider Demographics
NPI:1699573055
Name:JACKSON, ERICKA J
Entity type:Individual
Prefix:MISS
First Name:ERICKA
Middle Name:J
Last Name:JACKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-0284
Mailing Address - Country:US
Mailing Address - Phone:978-467-3011
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 284
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-0284
Practice Address - Country:US
Practice Address - Phone:978-467-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife