Provider Demographics
NPI:1235898081
Name:JACKSON, CIGNE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:CIGNE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:CIGNE
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT, ATC
Mailing Address - Street 1:2315 E JOLLY RD APT 6
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8298
Mailing Address - Country:US
Mailing Address - Phone:907-750-4002
Mailing Address - Fax:
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2306
Practice Address - Country:US
Practice Address - Phone:907-750-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010023872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer