Provider Demographics
NPI:1902259146
Name:LANEJACKSON, FRANCIS
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:LANEJACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 17TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-7011
Mailing Address - Country:US
Mailing Address - Phone:330-990-2883
Mailing Address - Fax:
Practice Address - Street 1:118 17TH ST NW
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-7011
Practice Address - Country:US
Practice Address - Phone:330-990-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator