| Doctor Name: | DALEDA JACKSON |
| NPI Number: | 1407205008 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 17421 Telegraph Rd Detroit, MI - 482193165 |
| Business Phone Number: | 3132972975 |
| Business Fax Number: | |
| Mailing Address: | 19178 Rutherford St, DETROIT |
| State: | MI |
| Postal Code: | 482352345 |
| Phone Number: | 3136058599 |
| Fax Number: | |
| NPI Enumeration Date: | 06/06/2016 |
| NPI Last Update Date: | 06/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 247200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Technician, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user. |