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Individual
MRS. URSULA ANN JACKSON
Active
Individual
MRS. URSULA ANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
006586
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006586
LICENSE
CT
Enumeration date
11/25/2009
Last updated
12/02/2009
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