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Individual
SAMANTHA J JACKSON
Active
Individual
SAMANTHA J JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
25126
MN
1041C0700X
Clinical Social Worker
L14321
OR
Other
Enumeration date
08/18/2021
Last updated
05/08/2024
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