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Individual
MARILYN SLEDGE JACKSON
Active
Individual
MARILYN SLEDGE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2160C
AL
1041C0700X
Clinical Social Worker
5411455-3501
UT
1041C0700X
Clinical Social Worker
CSW003706
GA
Other
Enumeration date
11/06/2010
Last updated
11/06/2010
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