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Individual
LUCY JACKSON
Active
Individual
LUCY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W.
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
127496-121
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100052220
—
WI
Enumeration date
03/19/2015
Last updated
09/07/2016
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